Pain specialists' evaluation of patient's prognosis during the first visit predicts subsequent depression and the affective dimension of pain

Objective: To examine the predictive value of physician's prognosis after patient's first visit to a pain specialty clinic. Design: This is a prospective-longitudinal study in which patients completed questionnaires regarding their pain and psychological constructs before their first visit to a pain specialist and again after an average of 5 months. Physicians rated patient's prognosis immediately after the first visit. Setting: This study was conducted at the outpatient specialty pain clinic at Soroka University Medical Center. Patients: Forty-five chronic pain patients suffering from a range of nonmalignant pain conditions. Outcome Measures: Sensory and affective pain measured by the Short-Form McGill Pain Questionnaire and depressive symptoms measured by the Center for Epidemiological Studies-Depression Scale. Results: Multiple regression analysis revealed that physician's rating of patient prognosis at Time 1 uniquely predicted subsequent depressive symptoms and affective pain but not sensory pain at Time 2 even after controlling for Time 1 levels of these variables. Conclusion: Physician's pessimistic evaluation of patient's prognosis after the first visit was longitudinally associated with an increase in depression and in the affective dimension of pain over time, but not with changes in the sensory component of pain. Referring to physician pessimism as a marker for pre-depressed patient may lead to early preventive interventions.