Pain Agreements and Healthcare Utilization in a Veterans Affairs Primary Care Population: A Retrospective Chart Review.

Introduction: The prevalence of chronic pain is enormous. In America, the management of chronic pain and opioids remains a critical focus. Guidelines recommend pain agreements as part of the management of chronic pain and opioids; however, evidence of improvement in patient outcomes is lacking. An aspect of patient outcome includes utilization of healthcare resources, such as emergency department visits and hospitalizations. It remains uncertain whether the use of pain agreements lessens healthcare utilization.

Methods: Retrospective chart review of a Midwest Veterans Affairs primary care clinic. Subjects were veterans on chronic opioids between 1 April 2014 and 1 April 2015. Outcome measures included emergency department visits, hospitalizations, clinic visits, telephone triage, telephone/secure messages, and nurse visits.

Results: The charts of 635 veterans on chronic opioids were reviewed. Of these, 295 were on a pain agreement. There were no significant differences in demographics, medical, or psychiatric diagnoses between patients with and without pain agreements. There were significant differences in opioid schedule and number of opioids based on pain agreement (p < 0.01). Patients on pain agreements did not utilize healthcare resources less than patients without a pain agreement. In fact, patients on pain agreements were likely to have more telephone calls, secure messages, and nurse visits compared with patients not on an agreement (p = 0.02).

Conclusions: Pain agreements are becoming standard of care for chronic pain management. However, there continues to be a lack of evidence demonstrating improvement in healthcare outcomes with their use, despite guideline recommendations. Further studies are needed to examine specific patient outcomes, such as overdose and death, in regard to pain agreements.

Funding: Advancing a Healthier Wisconsin-Patient-Centered Outcomes Research Program.