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Diagnosis or the patient? What matters more for prognosis

 •  • by Paul Ingraham
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Aasdahl et al showed that diagnosis doesn’t predict prognosis as well as the kind of person with the diagnosis. In other words, a certain type of person will probably do better or worse with any condition.

Cool. But also very here be dragons! 🐉 Details…

They studied how things went for 127 people with five common problems with no specific cause: pain in the neck, back, shoulder, or everywhere (“complex pain,” AKA fibromyalgia). So they were grouped by diagnosis. Imagine you put a couple dozen people with serious chronic back pain all in a room together. It probably wouldn’t take them long to figure out that they were all back pain patients.

And their prognosis? Predictably unpredictable, and mostly not great on average, with function improving modestly over a year, and pain somewhat less so.

But Aasdahl et al. also used a fancier sorting hat to group people by their traits from “across the biopsychosocial domains” — anything that has ever been considered a likely factor in prognosis, like pain intensity, activity level, sleep problems, mental distress, and many others. (This method comes from a complex prior study, Meisingset.)

Put everyone in one of these groups into a room together and they might never figure out what they have in common! But they would have more predictable outcomes for any of the conditions studied … for better or worse.

In this study, prognosis was affected less by the kind of pain a person had, and more affected by the kind of person living with it.

You might be nodding wisely now. We are all well trained to at least pay lip service to the importance of the person in healthcare.

But do we practice what we preach? No one actually talks about the prognosis for a type of person. Patients never ask, “How long will it take for someone like me to recover from any condition?”

Should we? Or should be careful what we wish for? Do you even want your doctor trying to give you a prediction based on what kind of person you are? Or, ack, trying to figure that out in the first place? How would that even work, and “what could possibly go wrong”?! I’m not sure the prognostic juice is worth the squeeze here!

But it’s certainly interesting to know that prognosis may actually be a function of who we are, rather than the specific way we’re hurting.

PainSci Member Login » Submit your email to unlock member content. If you can’t remember/access your registration email, please contact me. ~ Paul Ingraham, PainSci Publisher