Are Pain Screening and Functional Assessment Results Associated with New Diagnoses and Treatment for Pain in Primary Care? An Observational Study

Sarah Hudson Scholle; Tam T Nguyen-Louie; Lauren Bifulco; Jacquelyn W Blaz; Mary L Blankson; Veena Channamsetty; Daren R Anderson

doi:10.2147/JPR.S367480

Are Pain Screening and Functional Assessment Results Associated with New Diagnoses and Treatment for Pain in Primary Care? An Observational Study

J Pain Res. 2022 Aug 5:15:2249-2261. doi: 10.2147/JPR.S367480. eCollection 2022.

Authors

Sarah Hudson Scholle¹, Tam T Nguyen-Louie¹, Lauren Bifulco², Jacquelyn W Blaz¹, Mary L Blankson², Veena Channamsetty², Daren R Anderson²

Affiliations

¹ National Committee for Quality Assurance, Washington, DC, USA.
² Weitzman Institute, Community Health Center, Inc., Middletown, CT, USA.

Abstract

Purpose: To determine if pain screening and functional assessment results are associated with new diagnoses and treatment for pain in primary care.

Patients and methods: Observational study at 13 primary care sites of a statewide federally qualified health center that implemented routine screening and functional assessment for all adults in primary care. The study group included 10,091 adults aged 18+ who had an in-person visit between July 2, 2018, and June 1, 2019, where they screened positive for chronic pain and completed a 3-question functional assessment with the PEG (Pain, Enjoyment of Life, General Activity). Multivariate logistic regressions quantified associations between pain frequency, diagnosis and treatment, sociodemographics, comorbidities, and self-reported severe pain impairment with pain diagnoses and treatment documented after screening.

Results: Patients were mostly women (60.3%), Latinx (41.1%), English-speaking (80.1%), and Medicaid-insured (62.0%); they averaged 49.1 years old (SD = 13.7 years). Patients with severe pain impairment or who were Latinx were more likely to get a newly documented pain diagnosis (absolute risk difference [ARD]: 13.2% and 8.6%, ps < 0.0001), while patients with mental health/substance use or medical comorbidities were less likely (ARDs: -20.0% to -6.2%, ps < 0.001). Factors most consistently associated with treatment were prior treatment of the same modality (4 of 7 treatments, ARDs = 27.3% to 44.1%, ps <0.0001), new pain diagnosis (5 of 7, ARDs = 3.2% to 27.4%, ps <0.001), and severe impairment (4 of 7, ARDs = 2.6% to 6.5%, ps < 0.0001). A new diagnosis had the strongest association with non-opioid pain analgesics and physical medicine (ARD = 27.0% and 27.4%, p < 0.0001). Latinx patients were less likely to receive opioid analgesics and mental health/substance use medications and counseling (ARDs = -3.3% to 7.5%, ps <0.0001).

Conclusion: Screening and assessment with patient-reported tools may influence pain care. Care for Latinx patients differed from non-Latinx white patients.

Keywords: PEG; chronic pain; equity; federally qualified health center; patient-reported outcome measures; primary care.

Grants and funding

This project was supported by grant number 5R18HS025354-02 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. The funding organization had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and the decision to submit the manuscript for publication.