Unmet Needs in the Management of Functional Impairment in Patients with Chronic Pain: A Multinational Survey

Figures & data

Figure 1. Overall responses by all respondents (n = 143) to question 1 regarding the factors that help to identify chronic pain patients at risk of functional impairment.

Green indicates scores of 1 or 2, blue for scores of 3–5, and purple for scores of 6 or 7.

Table 1. Rankings, overall and by region, for responses to question 1: what are the key issues leading to a high proportion of chronic pain patients experiencing functional impairment?

Multiple choice answers	Overall		Western Europe		Latin America		Rest of the world
	Ranking	Mean score^†	Ranking	Mean score^†	Ranking	Mean score^†	Ranking	Mean score^†
Lack of sufficient knowledge about how to manage chronic pain patients in primary care	1	5.7	2	5.3	1	5.9	2	5.5
Lack of resource/time to assess and manage chronic pain patients in primary care	2	5.5	1	5.6	3	5.4	1	6.0
Lack of sufficient tools for primary care physicians to identify patients at increased risk of functional decline	3	5.3	3	5.0	4	5.4	4	5.5
Waiting times/capacity in secondary care	4	5.3	5	5.0	2	5.5	3	5.5
Ineffective communication between patients and physicians	5	4.9	4	5.0	6	4.7	5	5.0
Concerns regarding safety of current treatment options	6	4.5	7	3.8	5	4.8	7	5.0
Ineffective treatment options	7	4.3	6	3.8	7	4.3	6	5.0

† On a scale from 1 to 7, where 1 = not an issue and 7 = major issue. Items were ranked according to the number of respondents rating each issue with the highest scores; therefore, items with the same mean score could have different rankings.

Figure 2. Overall responses by all respondents (n = 143) to question 2 regarding the factors that help to identify chronic pain patients at risk of functional impairment.

Green indicates scores of 1 or 2, blue for scores of 3–5 and purple for scores of 6 or 7.

Table 2. Rankings, overall and by region, for responses to question 2: what would help to identify chronic pain patients at increased risk of long-term functional impairment?

Multiple choice answers	Overall		Western Europe		Latin America		Rest of the world
	Ranking	Mean score^†	Ranking	Mean score^†	Ranking	Mean score^†	Ranking	Mean score^†
Training for primary care physicians	1	6.0	1	5.6	1	6.2	1	6.2
Guideline recommendations focused on assessing functionality	2	5.9	2	5.3	2	6.1	4	6.1
Practical tools to assess functionality	3	5.7	3	5.3	4	5.8	3	6.1
Validated metrics to measure functionality	4	5.7	6	5.0	3	6.0	2	6.1
Tools for patients to help improve dialogue with physicians	5	5.5	4	5.2	5	5.8	5	5.9
Tools for physicians to help improve dialogue with patients	6	5.5	5	5.0	6	5.7	6	5.9

† On a scale from 1 to 7, where 1 = not helpful and 7 = very helpful. Items were ranked according to the number of respondents rating each issue with the highest scores; therefore, items with the same mean score could have different rankings.

Table 3. Responses to question 3: which metrics might provide an early warning sign for patients at increased risk of functional decline?

Hard clinical assessments (% respondents recommending each)

Soft clinical assessments (% respondents recommending each)

Visual analogue scales (12%) Psychological assessment (10%) Short Form-36 (7%) Numerical rating scales (5%) Barthel scale (4%) DN4 questionnaire (4%) Oswestry disability index (4%) Karnofsky scale (3%) 6-min walk test (3%) Quantitative sensory testing (2%) Brief pain inventory (2%) Functional independence measure (2%) WOMAC osteoarthritis index (2%) Adverse events (2%) Other clinical measure^† (15%) Other scale/questionnaire^‡ (20%)

Activity level, physical capacity or functionality^§ (24%) Pain-related measures^¶ (16%) Time off work (14%) Sleep (11%) Quality of life (8%) Social involvement (6%) Independence/self-care (6%) Catastrophic behaviour/kinesiophobia (5%) Impact on activities of daily living (3%) Stress (3%) Sexual function (3%) Mood (3%)

† Other clinical measures suggested by respondents included age, weight, history/monitoring and physiatric assessment.

‡ Respondents mentioned 17 other specific scales/questionnaires: Health Assessment Questionnaire Disability Index, Edmonton Scale, McGill Pain Questionnaire, StarT Back Screening Tool, International Classification of Functioning, Disability and Health Core Set, Lawton Scale, Tampa Scale, Canadian Occupational Performance Measure, Lattinen Index, Confusion Assessment Method, Visual Pain Map, Perception Scale, Screening Tools, Pain Detection Questionnaire, Clinical Questionnaires, Assessment Tools and Diagnostic Tool for Neuropathic Pain.

§ Includes various specific assessments tracked over time and nonspecific measures including exercise capability, functionality and active lifestyle tracking.

¶ Pain-related warning signs rather than specific pain scales.

DN4: Douleur neuropathique 4; WOMAC: Western Ontario MacMaster.

Data sharing statement

Data are available on request from Grünenthal. However, all data generated or analyzed during this study are included in this published article/as supplementary information files.