Annals of Family Medicine -- Comments for Bertakis et al., 2 (3) 224-230

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Original Research:
Klea D. Bertakis, Rahman Azari, and Edward J. Callahan
Patient Pain in Primary Care: Factors That Influence Physician Diagnosis
Ann Fam Med 2004; 2: 224-230 [Abstract] [Full text] [PDF]

TRACK: Submit a comment to this article

Electronic letters published:

Outpatient Use of Pain Scales: Laura L Novak (8 July 2004)

Consider Quailty of Life when identifying and evaluating pain.: Penney Cowan (26 May 2004)

Outpatient Use of Pain Scales 8 July 2004

Laura L Novak,
Barberton,USA
Asst dir, FPC residency
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Re: Outpatient Use of Pain Scales

Our FPC center is required by JCAHO to do a pain scale on all of our patients, no matter what their cheif complaint (even well child and newborn visits). I'm continually surprised at the number of smiling people who report their pain as 7 or greater and don't include any symptoms or complaints of pain. There are many secondary gains to be had in reporting pain at a high level, including disability payments and narcotics presciptions. Many of the 'validated' pain scales were done with inpatients with clear nocioceptive causes for their pain. In the complex field of chronic benign pain, I suspect they are much less useful.
Competing interests: None declared

Consider Quailty of Life when identifying and evaluating pain. 26 May 2004

Penney Cowan,
Rocklin, CA USA
Executive Director, American Chronic Pain Association
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Re: Consider Quailty of Life when identifying and evaluating pain.

It is clear to me that there is still a great deal of work to be done in all areas of medicine when it comes to diagnosis and treatment of pain. Because pain is so subjective, it might be more effective to talk about how ones daily life is affected by physical problems. Ask questions that will allow the physician to understand the impact the pain has had on level of functioning both at work and home. Lumping people into groups based on race and gender is misleading and does not provide a basis for pain levels but rather how they may report their pain and their expectations of relief. It is impossible for anyone but the person in pain to truly understand how it feels. The most that we can hope for is that our report of pain is believed, taken seriously and we are provided with a treatment plan that includes pain management. I am hopeful that in the months and years to come medicine will put more emphasis on the diagnosis and treatment of pain. As pointed out in this article, when pain is treated at the on-set, the recovery rate is much higher. We need to begin to think of pain as a disease and focus on prevention of pain by early diagnosis and appropriate treatment. Incorporating education on pain recognition methods into the medical curriculum is a good first step. Making it a requirement on all board examinations would provide patients with physicians, on all levels, with a working knowledge of how to assess and treat pain at the on-set.
Competing interests: None declared