Epidemiologic comparison of persistent pain sufferers in a specialty pain clinic and in the community.
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Most research into the causes and management of chronic pain has come from specialized chronic pain clinics, where patients have been selected through referral. Because it is assumed that persistent pain problems result in important socioeconomic and medical problems, it seemed important to determine whether the problems reported by patients in specialty pain clinics are characteristic of those reported by persistent pain sufferers in general. An epidemiologic study compared two groups of individuals with self-reported persistent pain complaints. One group was drawn randomly from a typical family medical group practice and the other was drawn from a specialized multidisciplinary pain clinic. The two groups were similar in most demographic variables, the length of the pain history, and the most commonly reported sites of pain. However, patients from the pain clinic were more likely to have had work-related accidents, to report greater health-care utilization, and to complain of more constant pain and greater levels of disability. Patients from the pain clinic reported greater impairment on the indices constructed to measure psychologic, social, and performance consequences of the pain experience. What most distinguished patients from the pain clinic was not medical factors alone, but reported impairment in function, and psychosocial difficulties. The implications are that patients referred to specialized pain clinics may not be representative of individuals in general who suffer persistent pain; the former likely require an interdisciplinary approach that includes attention to psychosocial and disability issues, not just medical or surgical treatments for pain.
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