{"doi":"10.1093/pm/pnaf005","title":"Patient-expressed goals in chronic pain management: a qualitative analysis of primary care visits","abstract":"Dear Editor: The 2022 opioid prescribing guidelines from the US Centers for Disease Control and Prevention (CDC) stress that developing mutually agreed on, objective goals for pain treatment is critical for safe opioid prescribing and effective pain treatment.1 However, these guidelines do not explain why physicians and patients often disagree about treatment goals, and there is little research detailing how and why patients with chronic pain discuss treatment goals during clinic visits. One study comparing patient treatment goals versus physician treatment goals found that patients’ top priorities were reducing pain intensity and finding a diagnosis for their pain, whereas physicians’ top priorities for those same patients were improving function and minimizing medication side effects.2 Qualitative studies found that patients tend to approach chronic pain through a biological lens, consider opioids to be a major source of pain relief, and work to have their pain treated as legitimate; physicians approach chronic pain from a biopsychosocial lens and try to avoid prescribing opioids.3–5 These studies used data that pre-dated the original 2016 CDC opioid prescribing guidelines. In the present study, we identified and characterized patients’ statements about pain treatment goals using newer data from primary care visits focused on chronic pain. Our study can provide insight into how goals are discussed during clinic visits, an important step toward helping clinicians set treatment goals and promote safer, more effective pain management. We analyzed transcripts of primary care visits audio-recorded for a previously conducted, institutional review board–approved study from December 2018 through August 2019.6 Participants were 48 adult primary care patients and 47 resident physicians from internal or family medicine primary care clinics. Patient participants were established adult clinic patients prescribed opioids for chronic pain (pain on most days for ≥3 months) who had a scheduled appointment to discuss pain management with an enrolled physician. Physicians were internal medicine or family medicine residents who had completed ≥1 year of residency training. Additional study details have been previously published.6 Authors reviewed the health communication literature and transcripts to identify and develop the following definition of patient goal statement: “a tangible reason given by the patient for wanting better pain treatment.” Patients could make multiple goal statements during a visit; each goal statement was coded separately. Next, authors independently reviewed 2–3 transcripts to identify patient goal statements and met as a group to compare results, discuss discrepancies, and refine definitions. This process was repeated with additional transcripts until all authors could reliably identify patient goal statements using a written codebook with minimal disagreement. Three authors independently applied the final codebook to all transcripts and met regularly to compare results. Disagreements were resolved through discussion or, if needed, with input from the senior author. The codebook is available by request from the corresponding author. Once all goal statements were identified, we characterized each statement according to the type of goal expressed, the kind of physician statements immediately preceding it, and the communicative function that seemed to motivate the patient’s goal statement, based on visit context. Patients’ mean age was 60.5 years; 71% identified as female; 33% identified as Black, and 38% as non-Hispanic White. Fifty-six percent (56%) were disabled or unable to work; 23% were retired. Additional demographics have been published previously.6 Transcripts contained a mean of 2.2 unique goal statements (median 1, interquartile range 0–6). Twenty-nine percent (29%) of visits (n = 14) contained no patient goal statements. As shown in Table 1, the most common goals patients mentioned were restoring physical func","journal":"Pain Medicine","year":2025,"id":560645,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9491,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1463071,"name":"Biftu M Mume","orcid":null,"position":1,"is_corresponding":false},{"id":1463072,"name":"Ebere I Sonoiki","orcid":null,"position":2,"is_corresponding":false},{"id":338927,"name":"Stephen G. Henry","orcid":"0000-0002-5643-0881","position":3,"is_corresponding":false},{"id":1463070,"name":"Cameron L Clerkley","orcid":null,"position":0,"is_corresponding":true}],"reference_count":11,"raw_metadata":null,"created_at":"2026-07-19T02:55:46.921885Z","pmid":"39836611","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}