Frequency and priority of pain patients' health care use

Increased health care use by pain patients is largely due to conditions other than their identified pain condition, but the kinds of services accounting for increased service use are poorly understood. This study assesses reasons for health care visits of pain patients versus controls, and compares characteristics of pain patients who differ in frequency and priority of service use.

The study samples included consecutive, primary care back pain (N=807), headache (N=831), and temporomandibular disorder pain (N=372) patients who were interviewed by telephone. Subsequently, age-sex matched controls with a primary care visit in the 6 months before the matched case's pain visit were identified. Over the following 3 years, diagnostic codes for health care visits were classified based on the Oregon Prioritized List of Health Services and case-control differences in major classes of care were compared. Pain patients differing in frequency and priority of service use were compared on measures of pain severity, chronicity, and psychosocial dysfunction.

Pain patients' increased health care use was sustained over 3 years. Increased utilization was largely due to symptomatic and ill-defined conditions, lower priority chronic disease, lower and higher priority acute disease, and mental health care. About one-half of the pain patients (vs. one-third of the controls) were frequent health care users. About one-third of the pain patients (vs. one-sixth of the controls) were frequent users who predominantly used medical care for lower priority conditions, and this difference accounted for most of the case-control difference in the prevalence of high users. Pain patients with frequent health care use had more severe pain and greater psychosocial dysfunction than pain patients with less frequent health care use. Among frequent users, pain patients who predominantly used services for lower priority conditions did not differ on measures of pain severity, chronicity, or somatization when compared with frequent users who typically used services for higher priority conditions.

The kind of problems explaining heightened service use of pain patients is more varied and complex than previously understood. These results call for increased attention to the implications of health care providers responding to presenting complaints as if each were a unique problem, without bringing continuity or an integrating perspective to patients' overall experience and management of illness.