Evaluation of a Chronic Pain Screening Program Implemented in Primary Care

Area of Science:

• Primary Care Medicine
• Pain Management
• Health Services Research

Background:

• Pain is a common symptom, yet primary care practitioners (PCPs) encounter challenges in its identification and assessment.
• Effective screening tools are crucial for managing chronic pain in primary care settings.

Purpose of the Study:

• To evaluate a novel 2-step process for chronic pain screening and follow-up within a primary care setting.
• To assess the feasibility and effectiveness of this screening method in identifying patients with chronic pain.

Main Methods:

• A cross-sectional study involving 68 PCPs and 58 medical assistants across 13 federally qualified health centers.
• Implementation of a 2-step screening: a single-question pain frequency assessment followed by the 3-question PEG (Pain, Enjoyment of Life, General Activity) assessment for positive screens.
• Analysis of adherence, screening results, PEG scores, and diagnosis of chronic painful conditions.

Main Results:

• 81.3% of 38,866 eligible patients underwent screening, with 32.5% screening positive for chronic pain.
• Of those screening positive, 94.5% completed the PEG questionnaire, revealing severe pain interference (PEG ≥7) in 59.1%.
• Nearly half (43.9%) of patients screening positive lacked a prior diagnosis; 52.9% received a new diagnosis within 90 days. Implementation barriers included administration time and comprehension issues.

Conclusions:

• The 2-step chronic pain screening and PEG assessment process is feasible and effective in identifying patients with previously undocumented chronic pain in primary care.
• Patient-reported pain frequency and interference provide valuable data for improving pain assessment and monitoring.
• While acceptable to care teams, workflow refinements are needed to address implementation challenges like administration time and question comprehension.