Physician Variability in the Management of Acute Postoperative and Cancer Pain: A Quantitative Analysis of the Michigan Experience

Abstract

A B S T R A C TBackground. Little is known about physician attitudes, goals, or satisfaction regarding acute postoperative and cancer pain management.Objectives. To provide quantitative data regarding the status of acute postoperative and cancer pain management by Michigan physicians. To measure physician confidence, preference, and satisfaction as well as identify their pain care goals for acute postoperative and cancer pain management. To evaluate variability in acute postoperative and cancer pain decision making based upon physician demographic characteristics, knowledge, and attitudes.Research Design. A cross-sectional survey, which included two cancer and three acute postoperative pain vignettes. Subjects.A randomly-selected sample of three hundred sixty-eight licensed Michigan physicians who provide clinical care for acute postoperative and cancer pain patients.Results. The majority of respondents (>50%) reported providing acute postoperative pain care frequently, while a minority (<20%) reported doing so for cancer pain. The majority of the physicians (>75%) reported goals of at least adequate pain relief without distress for both acute postoperative and cancer pain. Physicians more frequently chose the optimal pain management response for men following prostatectomy (56.2%) than for women following myomectomy (42%). They also chose the optimal response for metastatic prostate cancer more frequently (16.3%) than for metastatic breast cancer pain management (10.7%).Conclusion. These data highlight physician variability in acute postoperative and cancer pain management decision making. Further study of the physician variable is necessary to improve the management of acute postoperative and cancer pain.

Race, age, and gender influences among clusters of african american and white patients with chronic pain

“…However, the complex nature of pain management and limited information about patient characteristics might also limit the ability to appropriately and reliably predict pain treatment outcomes for the population at large. [31][32][33][34]78 Few studies have attempted to address the effects of pain cross-culturally, across the age continuum, or included the experiences of both women and men. 8,38,51 In addressing the complex nature of chronic pain management, there is a paucity of empirical research on the physical, social, and behavioral factors that might influence chronic pain outcomes, pain characteristics, and pain management in an ethnically diverse population.…”

Ethnicity interacts with the OPRM1 gene in experimental pain sensitivity

“…Indeed, relative to non-Hispanic whites, African Americans report higher levels of pain and disability associated with several pain conditions[1;3;24-28;67;68;82], including post-operative pain[29;43;53]. In addition, multiple studies have demonstrated greater experimental pain sensitivity among African Americans [6;7;17;30;59-61;69].…”

Patient demographic characteristics and facial expressions influence nurses’ assessment of mood in the context of pain: A Virtual Human and lens model investigation

“…Research indicates that healthcare providers – nurses in particular – are prone to underestimate the severity of patient pain compared to self-report, and that there is variability in pain ratings between and within provider types (Choiniere et al, 1990; Davoudi et al, 2008; Green et al, 2001; Green and Wheeler, 2003; Luger et al, 2003; Sloman et al, 2005). Relatively little has been published concerning the accuracy of nurses’ assessment of patient emotional status in general and in the context of pain in particular.…”