Clinical decision making in pain management: Contributions of physician and patient characteristics to variations in practice

Abstract

Differences in the quality of pain management may very well be due to physician characteristics and their treatment goals based on the type of pain or patient demographics. This study was done to (1) determine the role of physician characteristics in their goals and treatment of acute, cancer, and chronic pain and (2) provide an evaluation of the differences in physician pain management decision making due to patient characteristics and the type of pain being treated. A prospective cohort study of 368 Michigan physicians was done to determine their pain management knowledge, attitudes, and prescribing habits via study-specific multi-item mail survey. Nine clinical vignettes were used to examine potential differences in the physician's pain management based on the type of pain and patient demographic characteristics. The responses of the study group varied on the basis of the type of pain and gender of the patient. They were more likely to provide optimal treatment for men with acute postoperative or cancer pain. The physicians also reported lesser goals for relief of chronic pain when compared to acute and cancer pain. Lower goals for chronic pain relief may lead to the undertreatment of chronic pain. This study demonstrates that the provision of adequate pain management may be influenced by patient characteristics and physician variability. © 2003 by the American Pain Society.