Register      Login
Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

Factors associated with general practitioner visits for pain in people experiencing chronic pain

Dinberu Shebeshi https://orcid.org/0000-0002-0617-0209 1 * , Samuel Allingham 1 , Janelle White 1 , Hilarie Tardif 1 , David Holloway 1
+ Author Affiliations
- Author Affiliations

1 Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia.

* Correspondence to: dinberu@uow.edu.au

Handling Editor: Felicity Goodyear-Smith

Journal of Primary Health Care 15(3) 199-205 https://doi.org/10.1071/HC23004
Published: 26 April 2023

© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction: Patients with chronic pain (CP) are frequent users of general practitioners (GPs).

Aim: This study aimed to assess factors associated with the rate of GP visits related to pain in patients with CP.

Methods: This study used data collected by adult specialist pain management services (SPMS) that participated in the electronic Persistent Pain Outcomes Collaboration (ePPOC) in Australia. Adult patients (18 years or older) with CP (duration greater than 3 months) who were referred to SPMS from the calendar year 2015–2021 were included (N = 84 829).

Results: Patients who reported severe anxiety, stress, pain, pain interference, pain catastrophising and severely impaired pain self-efficacy were more likely to seek help from a GP. Patients with longer pain duration had a lower rate of GP visits. The rate of GP visits was 1.22 (IRR = 1.22, 95% CI: 1.19, 1.26) times higher in patients with severe pain severity, compared to patients with mild pain severity. Patients who used opioids were more likely to visit a GP (IRR = 1.32, 95% CI: 1.30, 1.34) than those who were not using opioids.

Discussions: More than half of the adult CP patients had greater than three GP visits in the 3 months before referral. This study would indicate that some patients may attend their GP to seek an opioid prescription. Given the rising use of opioids nationally, future study is required on opioid users’ GP visitation practices. Additionally, the inverse association between pain duration and the rate of GP visits warrants further exploration.

Keywords: chronic pain, general practitioner (GP), health care utilisation, pain interference, pain severity, patient-reported outcomes.


References

[1]  Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth 2019; 123 e273–83.
Chronic pain: a review of its epidemiology and associated factors in population-based studies.Crossref | GoogleScholarGoogle Scholar |

[2]  Fine PG. Long-term consequences of chronic pain: mounting evidence for pain as a neurological disease and parallels with other chronic disease states. Pain Med 2011; 12 996–1004.
Long-term consequences of chronic pain: mounting evidence for pain as a neurological disease and parallels with other chronic disease states.Crossref | GoogleScholarGoogle Scholar |

[3]  Beehler GP, Rodrigues AE, Mercurio-Riley D, et al. Primary care utilization among veterans with chronic musculoskeletal pain: a retrospective chart review. Pain Med 2013; 14 1021–31.
Primary care utilization among veterans with chronic musculoskeletal pain: a retrospective chart review.Crossref | GoogleScholarGoogle Scholar |

[4]  Foley HE, Knight JC, Ploughman M, et al. Association of chronic pain with comorbidities and health care utilization: a retrospective cohort study using health administrative data. Pain 2021; 162 2737–49.
Association of chronic pain with comorbidities and health care utilization: a retrospective cohort study using health administrative data.Crossref | GoogleScholarGoogle Scholar |

[5]  Australian Institute of Health and Welfare 2020. Chronic Pain in Australia. Cat. no. PHE 267. Canberra: AIHW; 2020.

[6]  Hadi MA, McHugh GA, Closs SJ. Impact of chronic pain on patients’ quality of life: a comparative mixed-methods study. J Patient Exp 2019; 6 133–41.
Impact of chronic pain on patients’ quality of life: a comparative mixed-methods study.Crossref | GoogleScholarGoogle Scholar |

[7]  Könning A, Rosenthal N, Friese M, et al. Factors associated with physician consultation and medication use in children and adolescents with chronic pain: a scoping review and original data. Eur J Pain 2021; 25 88–106.
Factors associated with physician consultation and medication use in children and adolescents with chronic pain: a scoping review and original data.Crossref | GoogleScholarGoogle Scholar |

[8]  Breivik H, Collett B, Ventafridda V, et al. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006; 10 287
Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment.Crossref | GoogleScholarGoogle Scholar |

[9]  Blyth FM, March LM, Brnabic AJM, et al. Chronic pain and frequent use of health care. Pain 2004; 111 51–8.
Chronic pain and frequent use of health care.Crossref | GoogleScholarGoogle Scholar |

[10]  Dueñas M, Ojeda B, Salazar A, et al. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res 2016; 9 457–67.
A review of chronic pain impact on patients, their social environment and the health care system.Crossref | GoogleScholarGoogle Scholar |

[11]  Painaustralia. National strategic action plan for pain management: evidence base companion document. Canberra: Painaustralia; 2019. Available at https://www.painaustralia.org.au/static/uploads/files/evidence-base-companion-document-action-plan-06-06-2019-wfvafzuuposr.pdf

[12]  Mann EG, Johnson A, VanDenKerkhof EG. Frequency and characteristics of healthcare visits associated with chronic pain: results from a population-based Canadian study. Can J Anaesth 2016; 63 411–41.
Frequency and characteristics of healthcare visits associated with chronic pain: results from a population-based Canadian study.Crossref | GoogleScholarGoogle Scholar |

[13]  Tardif H, Arnold C, Hayes C, et al. Establishment of the Australasian electronic persistent pain outcomes collaboration. Pain Med 2017; 18 1007–18.
Establishment of the Australasian electronic persistent pain outcomes collaboration.Crossref | GoogleScholarGoogle Scholar |

[14]  Lord SM, Tardif HP, Kepreotes EA, et al. The Paediatric electronic Persistent Pain Outcomes Collaboration (PaedePPOC): establishment of a binational system for benchmarking children’s persistent pain services. Pain 2019; 160 1572–85.
The Paediatric electronic Persistent Pain Outcomes Collaboration (PaedePPOC): establishment of a binational system for benchmarking children’s persistent pain services.Crossref | GoogleScholarGoogle Scholar |

[15]  Australian Bureau of Statistics. Socio-Economic Indexes for Areas (SEIFA). Canberra, Australia: Australian Bureau of Statistics; 2013.

[16]  Tardif H, Blanchard MB, Alexander TL. Socioeconomic disadvantage and referral to pain management services in Australasia. 2019. https://ro.uow.edu.au/ahsri/998/

[17]  WHO. A healthy lifestyle - WHO recommendations. 2021. Available at https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi [30 June 2021].

[18]  Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales: Psychology Foundation of Australia. 1996. https://www.scirp.org/(S(vtj3fa45qm1ean45vvffcz55))/reference/ReferencesPapers.aspx?ReferenceID=1262988

[19]  Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singap 1994; 23 129–38.

[20]  Sullivan MJL, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995; 7 524–32.
The pain catastrophizing scale: development and validation.Crossref | GoogleScholarGoogle Scholar |

[21]  Allingham S, Tardif H, Bryce M, et al. Patient Outcomes in Pain Management: Enterprise One Pain Management Service, 2020 Annual Report for 1 January to 31 December 2020. Electronic Persistent Pain Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong; 2021.

[22]  Nicholas MK. Self-efficacy and chronic pain. St Andrews: Annual Conference of British Psychological Society; 1989.

[23]  Karazsia BT, van Dulmen MHM. Regression models for count data: illustrations using longitudinal predictors of childhood injury. J Pediatr Psychol 2008; 33 1076–84.
Regression models for count data: illustrations using longitudinal predictors of childhood injury.Crossref | GoogleScholarGoogle Scholar |

[24]  Ripley B, Venables B, Bates DM, et al. Package ‘mass’. Cran r 2013; 538 113–20.

[25]  Newman AK, Kapoor S, Thorn BE. Health care utilization for chronic pain in low-income settings. Pain Med 2018; 19 2387–97.
Health care utilization for chronic pain in low-income settings.Crossref | GoogleScholarGoogle Scholar |

[26]  Dunlop AJ, Lokuge B, Lintzeris N. Opioid prescribing in Australia: too much and not enough. Med J Aust 2021; 215 117–8.
Opioid prescribing in Australia: too much and not enough.Crossref | GoogleScholarGoogle Scholar |

[27]  Goesling J, Henry MJ, Moser SE, et al. Symptoms of depression are associated with opioid use regardless of pain severity and physical functioning among treatment-seeking patients with chronic pain. J Pain 2015; 16 844–51.
Symptoms of depression are associated with opioid use regardless of pain severity and physical functioning among treatment-seeking patients with chronic pain.Crossref | GoogleScholarGoogle Scholar |

[28]  Mann EG, LeFort S, VanDenKerkhof EG. Self-management interventions for chronic pain. Pain Manag 2013; 3 211–22.
Self-management interventions for chronic pain.Crossref | GoogleScholarGoogle Scholar |

[29]  Budge C, Taylor M, Mar M, et al. Chronic pain: good management of practical pain control strategies is associated with being older, more health activated and having better mental health. J Prim Health Care 2020; 12 225–34.
Chronic pain: good management of practical pain control strategies is associated with being older, more health activated and having better mental health.Crossref | GoogleScholarGoogle Scholar |

[30]  Clare A, MacNeil S, Bunton T, et al. ‘The Doctor doesn’t need to see you now’: reduction in general practice appointments following group pain management. Br J Pain 2019; 13 121–9.
‘The Doctor doesn’t need to see you now’: reduction in general practice appointments following group pain management.Crossref | GoogleScholarGoogle Scholar |

[31]  Jonsdottir T, Jonsdottir H, Lindal E, et al. Predictors for chronic pain‐related health care utilization: a cross‐sectional nationwide study in Iceland. Health Expect 2015; 18 2704–19.
Predictors for chronic pain‐related health care utilization: a cross‐sectional nationwide study in Iceland.Crossref | GoogleScholarGoogle Scholar |

[32]  Gerdle B, Björk J, Henriksson C, et al. Prevalence of current and chronic pain and their influences upon work and healthcare-seeking: a population study. J Rheumatol 2004; 31 1399–406.

[33]  Gauntlett-Gilbert J, Brook P. Living well with chronic pain: the role of pain-management programmes. BJA Educ 2018; 18 3–7.
Living well with chronic pain: the role of pain-management programmes.Crossref | GoogleScholarGoogle Scholar |

[34]  Gannon B, Finn DP, O’Gorman D, et al. The cost of chronic pain: an analysis of a regional pain management service in Ireland. Pain Med 2013; 14 1518–28.
The cost of chronic pain: an analysis of a regional pain management service in Ireland.Crossref | GoogleScholarGoogle Scholar |