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N+R-Vol-2

ISSUE NO 2 3 NEWS & REVIEWS ISSUE NO 2 Dr Gerhard H.H. Müller-Schwefe To provide optimal pain manage- ment, healthcare professionals need to consider not only their patients' present status of pain but also individual expectations. Effective communication is required to fully understand a particular patient's condition but is very often compromised by communication barriers from both physicians and patients. Poor communication between physicians and patients has been demonstrated by a German study in which physicians and patients as- sessed separately patients pain in- tensity and the pain dependent impairment in rehabilitation training in chronic low back pain patients. Only in 19.4 % physicians precisely rated pa- tient’s pain and impairment. The relevance of adequate pain assessment is high- lighted by a responder rate of 92.3 % in this group (see Figure 1). Language barriers, cultural traditions, cognitive impair- ment or misunderstanding may influence communica- tion between physicians and patients. Patients may also be reluctant to report pain due to low expectations of obtaining effective analgesia or they may fear drug-related adverse effects, tolerance or CHANGE PAIN SCALE – A NEW TOOL FOR IMPROVING PHYSICIAN-PATIENT COMMUNICATION RESPONDER RATE Physician = Patient Physician > Patient Physician < Patient 0 10 20 30 40 50 60 70 80 90 100 (%) 92.3 % 71.7 % 24.3 % ASSESSMENT OF PAIN RELATED IMPAIRMENT Physician = Patient Physician > Patient Physician < Patient 0 10 20 30 40 50 60 70 80 90 100 (%) 19.4 % 28.4 % 52.2 % Adequate pain assessment In order to improve communication between healthcare professionals and patients detailed documenta- tion of pain and quality of life as- pects are recommended. Current assessment of pain is primarily done through methods focusing on the quantification of pain, such as the Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), and Verbal Rating Scale (VRS). Although these scales may be useful in clini- cal studies and for the follow up of pain development, they are of little use for singular assessment of pain severity. Since these scales are very much based on a subjective estimation of the severity of pain, there is frequently a disparity between the clinician’s and patient’s rating of pain intensity with clini- cians often underestimating the sit- uation (Glajchen, 2001). Moreover, even among physicians there is no common understanding where se- addiction (Glajchen, 2001). Many pa- tients complain that their pain is not taken seriously enough and not ade- quately managed due to physicians' lack of knowledge about pain and unsuccessful pain treatment (Roper Starch Worldwide, 1999). This is even more distressing since patient satisfaction is highly corre- lated with the healthcare provider’s attention to the treatment of pain (McCracken, 2002). Thorough eval- uation of pain sufferers’ problems and understandable explanations of conditions and treatment op- tions contribute to patients’ willing- ness to report their pain related impairment. Figure 1: Physicians' frequently underestimate patients' pain and impairment Adapted from Müller-Schwefe, 2004.