Are You Keeping Your Doctor in the Dark?

Many chronic pain patients don’t tell their doctors when they seek alternative treatments.

Chronic pain affects approximately 100 million Americans each year and costs nearly $600 billion, according to a report from the Institute of Medicine. A study by Kaiser Permanente has found that many chronic pain patients often don’t tell their doctors when they seek alternative treatments.

The study, published in the American Journal of Managed Care, found that more than half of chronic pain patients in a managed care setting reported using alternative therapies, but many didn’t discuss this care with their primary care providers. Researchers surveyed more than 6,000 Kaiser Permanente patients in Oregon and Washington who had three or more outpatient visits for chronic pain within 18 months. They found that 58% of these patients had used a chiropractor, acupuncture or both.

The majority shared information about these alternative therapies with their primary care provider, however 35% of those who had acupuncture only and 42% of those who had chiropractic care only didn’t talk to their providers about this care. Interestingly, almost all of these patients said they would have been willing to share the information had their provider asked them.

“Our study confirms that most of our patients with chronic pain are seeking complementary treatments to supplement the care we provide in the primary care setting,” said Charles Elder, MD, MPH, lead author of the study and affiliate investigator at the Kaiser Permanente Center for Health Research. “The problem is that too often, doctors don’t ask about this treatment, and patients don’t volunteer the information. We want our patients to get better, so we need to ask them about the alternative and complementary approaches they are using. If we know what’s working and what’s not working, we can do a better job advising patients, and we may be able to recommend an approach they haven’t tried.”

Elder went on to admit that from a public health standpoint, our management of chronic pain is woefully inadequate. And a breakdown in communication between patient and physician can only make matters worse. “Managing pain is complex,” Elder said. It can involve a variety of different approaches, such as behavior changes, medications, therapies and procedures. When treating pain, doctors need to be aware of what approaches a person is and isn’t using, what methods may be working and which practitioners that individual is seeing. Doctors need to know the big picture so that we can offer patients the full spectrum of care in a coordinated way.”