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Do Your Pain Patients Use Complementary Therapies? Just Ask

PORTLAND, OR – What are your chronic pain patients not telling you?

A study, published recently in the American Journal of Managed Care, finds that many patients use alternative measures to control pain but don’t discuss them with their primary care providers.

The information also is not documented in electronic medical records as often as it should be, according to the report.

Kaiser Permanente researchers surveyed more than 6,000 health plan members in Oregon and Washington from 2009-11 who had three or more outpatient visits for chronic pain within 18 months, determining that 58% had used chiropractic care, acupuncture or both.

While a majority of patients told their primary care providers about their use of alternative therapy, 35% of those who had acupuncture only and 42% who had chiropractic care only didn’t let them know.

“The use of acupuncture and chiropractic care among HMO chronic pain patients responding to our survey was substantial,” the authors write. “Those using neither acupuncture nor chiropractic care (42%) were in the minority. The data also suggest that a substantial percentage of acupuncture and chiropractic use is not documented by the EMR, and/or is not reported by patients to their HMO clinicians.”

Yet nearly all said they would have readily shared the information if their provider had only asked. Most of the patients in the study, 71%, were female with a mean age of 61; common complaints included back pain, joint pain, arthritis, extremity, neck and muscle pain, and headache.

"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 lead author Charles Elder, MD, MPH, 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."

For the study, researchers examined the medical records of patients who received acupuncture or chiropractic care in 2011. The majority of the acupuncture patients, 66%, accessed the services through their health plan, using a clinician referral or self-referral benefit. The same was true for about half, 45%, of patients getting chiropractic care.

Study participants completed online or by mail a survey that included 17 questions about the type of pain patients experienced, and their use of acupuncture, chiropractic care, and other alternative and complementary therapies.