How Do Your Patients Perceive Pain?

A significant portion of patients with rheumatoid arthritis don’t feel they have effective communication with their rheumatologists, according to a small qualitative study.

Patient perceptions of pain and fatigue can differ from clinical markers. Knowing this can encourage rheumatologists to take patient responses into account when designing treatment plans.

In a presentation given on Nov. 10 at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., Mayo Clinic rheumatologist John M. Davis III, discussed how frequently patients report severe rheumatoid arthritis symptoms that exceed the objective markers their rheumatologists observe. 

Results suggest patients experience a disconnect with their doctors, friends and family members that contributes to the psycho-social burden of disease. The findings can help providers recognize patients who feel their concerns aren’t being heard, he said, as well as open the door to more transparent patient-physician discussions.

“The sense is if we engage with patients and are attentive to their unmet needs, in terms of complaints and coping with symptoms,” he said, “we’ll have a better sense of what’s going on with patients.”

Based on patient responses through the Clinical Disease Activity Index, the pain visual analog scale, and the Patient Health Questionnaire-9, patient-physician discordance appears in 33 percent of clinical encounters even though not all patients are dissatisfied with their doctors. Patient-physician concordance is defined by a >25-mm absolute difference in these global assessments of their disease activity during the patient’s most recent rheumatology appointment within the previous four weeks.  

Patients who report discordance also report high levels of fatigue, pain and difficulty with activities, he said, even though the number of swollen joints and CRP protein levels don’t indicate the same level of disease activity.

Disclosures:

The study was funded by the Mayo Clinic Eaton Family Career Development Award in Innovative Rheumatoid Arthritis Research.

References:

“It Was Like No One Is Listening to Me: A Qualitative Study of the Lived Experiences of Patients with Rheumatoid Arthritis in the Setting of Patient-Physician Discordance in Assessments of Disease Activity;” Nov. 10, 2015; 9a.m-11a.m. ACR 2015.