The entire primary care record of six patients attending a community-based education/exercise self-management program for chronic noncancer pain (YMCA Pain Exercise/Education Program [Y-PEP]) was reviewed. Medical visits, consultations and hospital admissions were coded as related or unrelated to their pain diagnoses. Mood disruption, financial concerns, conflicts with employers/insurers, analgesic doses, medication side effects and major life events were also recorded. The ‘chronic pain trajectory’ resembled a roller coaster with increased health care visits at the time of initial injuries and during ‘crises’ (reinjury, conflict with insurers/employers, failed back-to-work attempts and life events). Visits decreased when conflicts were resolved. Analgesic doses increased during ‘crises’ but did not fall after resolution. After attending Y-PEP, health care use fell for four of six patients and two returned to work. Primary care physicians need to recognize the functional limitations and psychosocial complications experienced by their chronic pain patients. A program such as Y-PEP may promote active self-management strategies resulting in lowered health care use.

中文翻译：

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慢性疼痛的轨迹：以社区为基础的运动/教育计划是否可以使骑车顺风顺水？

回顾了参加基于社区的慢性非癌性疼痛教育/运动自我管理计划（YMCA疼痛运动/教育计划[Y-PEP]）的六名患者的全部初级护理记录。医疗访问，咨询和住院均被编码为与疼痛诊断相关或无关。还记录了情绪中断，财务问题，与雇主/保险公司的冲突，止痛剂量，药物副作用和重大生命事件。“慢性疼痛的轨迹”类似于过山车，在初次受伤时和“危机”期间（重伤，与保险公司/雇主发生冲突，重返工作的尝试失败和生活事件）增加了就诊次数。解决冲突后，访问量减少了。在“危机”期间，镇痛剂量有所增加，但在解决后并未下降。参加Y-PEP之后 六名患者中有四名减少了医疗保健使用，两名恢复了工作。初级保健医生需要认识到其慢性疼痛患者的功能局限性和心理社会并发症。诸如Y-PEP之类的程序可能会促进积极的自我管理策略，从而降低医疗保健的使用。