Consensus on functional assessment of chronic pain in primary care: a Delphi study.

Background: Chronic pain is a public health concern affecting 20-30% of the population of Western countries. Focus groups of people with persistent pain indicated that their overall physical function had deteriorated because of pain, therefore assessment of function should be an integral part of pain assessment. The objective of this study was to establish a consensus on assessment of function in chronic pain primary care patients and to evaluate the use of scales and clinical guidelines in clinical practice.

Methods: A Delphi study (CL4VE study) was carried out. A group of primary care physicians, were asked to rate how strongly they agreed/disagreed with the statements in: general functioning data, and functioning outcomes in chronic pain patients.

Results: Seventy-one primary care physicians were invited to participate. Of these, 69 completed Round 1 (98.5% response rate), and 68 completed Round 2 (97.1%). Under the predefined criterion, a high degree of agreement (91.4%) was observed, this was confirmed in 32 of 35 questions in the second round. Discrepancies were noted, firstly, because functioning was only linked to joint recovery; secondly, in the use of specific scales and questionnaires to measure functioning, and thirdly, that no scale of functioning is used in clinical practice due to complexity and lack of time for assessment.

Conclusions: Physicians agreed on the need for a precise definition of the concept of patient functional impediment to facilitate homogeneous recognition, and for the development of simple and practical scales focused on patients with chronic pain and their needs.