• Sangeeta C Ahluwalia, Karleen F Giannitrapani, Steven K Dobscha, Risa Cromer, and Karl A Lorenz.
• RAND Corporation, Santa Monica, California; UCLA Fielding School of Public Health, Los Angeles, California. Electronic address: sahluwal@rand.org.
• J Pain. 2018 May 1; 19 (5): 562-568.

AbstractThe "Pain as the 5th Vital Sign" initiative intended to address undertreatment of pain by encouraging routine pain assessment and management. In the Veterans Health Administration, routine pain screening has been practiced in primary care for more than a decade, but has not improved the quality of pain management measured using several process indicators, and some have expressed concerns of potentially fostering undesirable use of prescription opioids. We sought to evaluate the consequences of routine pain screening on clinical practice. We conducted 9 interdisciplinary focus groups with 60 primary care providers and staff from 5 outpatient Veterans Health Administration clinics. We identified 5 themes reflecting 1 intended and 4 unintended consequences of routine pain screening: it 1) facilitates identification of patients with pain who might otherwise be overlooked, 2) may need to be targeted toward specific patients and contexts rather than universally applied, 3) often shifts visit focus away from more emergent concerns, 4) may encourage "false positives" and prompt providers to intervene when treatment is not a priority, and 5) engenders a "pain problem" and hinders patients from considering alternative strategies. These findings suggest changes to support patient-centered pain assessment and improve targeted screening and interventions for population pain management.Copyright © 2018 The American Pain Society. All rights reserved.

25 keywords...

hide…