Correlation of patient- and clinician-assessment of pain: comparing physiotherapy and general practice
Sarah J. White
A B , Mark Butlin A , Alicia Brown A and Ross White A
A Faculty of Medicine, Health and Human Sciences, Level 3, Talavera Road, Macquarie University, NSW 2109, Australia.
B Corresponding author. Email: sarah.white@mq.edu.au
Australian Journal of Primary Health 27(4) 291-296 https://doi.org/10.1071/PY20214
Submitted: 24 September 2020 Accepted: 25 January 2021 Published: 29 March 2021
Abstract
The clinical work of GPs and physiotherapists frequently involves the assessment of patient pain. In this study, we aimed to determine the correlation of patient- and clinician-assessment of severity of pain through quantitative analysis of patient- and clinician-assessed pain scores collected at metropolitan general practice and physiotherapy clinics. Prior to a consultation, 30 patients were asked to complete a short general health survey within which they answered questions regarding current pain and, if in pain, the severity of that pain on the visual analogue scale. Following the consultation, their clinicians were asked questions on their observation of the patients, including whether they observed that their patients were in pain and, if so, how severe on the visual analogue scale. Statistical analysis of these data showed that although there was a correlation between the physiotherapist- and patient-assessed pain scores, there was no correlation between the GP- and patient-assessed pain scores. Accurately establishing the severity of patient pain can be difficult. These results suggest that GPs routinely underestimate the severity of patient pain. If the severity of patient pain is clinically relevant, GPs could improve the accuracy of assessment by asking patients directly about that aspect of pain.
Keywords: general practitioner, pain assessment, pain measurement, physiotherapist, primary care, visual analogue scale.
References
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 327, 307–310.| Statistical methods for assessing agreement between two methods of clinical measurement.Crossref | GoogleScholarGoogle Scholar |
Breivik H (2016) Fifty years on the Visual Analogue Scale (VAS) for pain-intensity is still good for acute pain. But multidimensional assessment is needed for chronic pain. Scandinavian Journal of Pain 11, 150–152.
| Fifty years on the Visual Analogue Scale (VAS) for pain-intensity is still good for acute pain. But multidimensional assessment is needed for chronic pain.Crossref | GoogleScholarGoogle Scholar | 28850458PubMed |
Burckhardt CS, Jones KD (2003) Adult measures of pain: the McGill Pain Questionnaire (MPQ), Rheumatoid Arthritis Pain Scale (RAPS), Short-Form McGill Pain Questionnaire (SF-MPQ), Verbal Descriptive Scale (VDS), Visual Analog Scale (VAS), and West Haven-Yale Multidisciplinary Pain Inventory (WHYMPI). Arthritis and Rheumatism 49, S96–S104.
| Adult measures of pain: the McGill Pain Questionnaire (MPQ), Rheumatoid Arthritis Pain Scale (RAPS), Short-Form McGill Pain Questionnaire (SF-MPQ), Verbal Descriptive Scale (VDS), Visual Analog Scale (VAS), and West Haven-Yale Multidisciplinary Pain Inventory (WHYMPI).Crossref | GoogleScholarGoogle Scholar |
Chapman EN, Kaatz A, Carnes M (2013) Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. Journal of General Internal Medicine 28, 1504–1510.
| Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities.Crossref | GoogleScholarGoogle Scholar | 23576243PubMed |
Cintron A, Morrison RS (2006) Pain and ethnicity in the United States: a systematic review. Journal of Palliative Medicine 9, 1454–1473.
| Pain and ethnicity in the United States: a systematic review.Crossref | GoogleScholarGoogle Scholar | 17187552PubMed |
Craig KD, Versloot J, Goubert L, Vervoort T, Crombez G (2010) Perceiving pain in others: automatic and controlled mechanisms. The Journal of Pain 11, 101–108.
| Perceiving pain in others: automatic and controlled mechanisms.Crossref | GoogleScholarGoogle Scholar | 19962352PubMed |
Glowacki D (2015) Effective Pain management and improvements in patients’ outcomes and satisfaction. Critical Care Nurse 35, 33–41.
| Effective Pain management and improvements in patients’ outcomes and satisfaction.Crossref | GoogleScholarGoogle Scholar | 26033099PubMed |
Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care & Research (Hoboken) 63, S240–S252.
| Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP).Crossref | GoogleScholarGoogle Scholar |
Heath C (1989) Pain talk: the expression of suffering in the medical consultation. Social Psychology Quarterly 52, 113–125.
| Pain talk: the expression of suffering in the medical consultation.Crossref | GoogleScholarGoogle Scholar |
Kappesser J, de C Williams AC (2010) Pain estimation: asking the right questions. Pain 148, 184–187.
| Pain estimation: asking the right questions.Crossref | GoogleScholarGoogle Scholar | 19880252PubMed |
Levy N, Sturgess J, Mills P (2018) ‘Pain as the fifth vital sign’ and dependence on the ‘numerical pain scale’ is being abandoned in the US: why? British Journal of Anaesthesia 120, 435–438.
| ‘Pain as the fifth vital sign’ and dependence on the ‘numerical pain scale’ is being abandoned in the US: why?Crossref | GoogleScholarGoogle Scholar | 29452798PubMed |
Seers T, Derry S, Seers K, Moore RA (2018) Professionals underestimate patients’ pain. Pain 159, 811–818.
| Professionals underestimate patients’ pain.Crossref | GoogleScholarGoogle Scholar | 29351169PubMed |
Tait RC, Chibnall JT, Miller L, Werner CA (2011) Judging pain and disability: effects of pain severity and physician specialty. Journal of Behavioral Medicine 34, 218–224.
| Judging pain and disability: effects of pain severity and physician specialty.Crossref | GoogleScholarGoogle Scholar | 21080049PubMed |
