More than a pain in the neck: how discussing chronic pain affects hypertension medication intensification

Abstract

Background: A difficult to manage comorbid condition, like chronic pain, could adversely affect the delivery of recommended care for other serious health problems, such as hypertension.

Objective: We examined whether addressing pain at a primary care visit acts as a competing demand in decisions to intensify blood pressure (BP) medications for diabetic patients with an elevated BP.

Design: Prospective cohort study.

Participants: 1,169 diabetic patients with a BP > or = 140/90 prior to a primary care provider (PCP) visit were enrolled.

Measurements: After the visit, PCPs provided information about the top three issues discussed and whether hypertension medications were intensified or reasons for not intensifying. We used multi-level logistic regression to assess whether discussing pain during the visit decreased the likelihood of BP medication intensification. We calculated predicted probabilities of medication intensification by whether pain was discussed.

Results: PCPs discussed pain during 222 (20%) of the visits. Visit BP did not differ between patients with whom pain was and was not discussed. BP medications were intensified during 44% of the visits. The predicted probability of BP medication intensification when pain was discussed was significantly lower than when pain was not discussed (35% vs. 46%, p = 0.02).

Conclusions: Discussing pain at a primary care visit competed with the intensification of BP medication. This finding is concerning given that controlling blood pressure may be the most important factor in decreasing long-term complications for patients with diabetes. Better care management models for complex patients are needed to ensure that both pain and other chronic conditions are adequately addressed.

Figure 1

Predicted probability of blood pressure medication intensification for those with whom pain was and was not discussed derived from the logistic regression model shown in Table 2 with values for all other variables in the model set to the sample mean.