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 ≥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.
KEY WORDS chronic pain - comorbidity - hypertension management