Rurality and use of specialty clinic referrals in primary care management of chronic pain: a retrospective study.

BACKGROUND

We compared referrals to pain management specialists between rural and urban primary care clinics within a single academic healthcare network (integrating hospital and outpatient services) in the Southeastern United States.

MATERIALS &

METHODS

We retrospectively queried primary care visits in 2022 with chronic pain-associated diagnosis codes, stratified by rural vs. urban clinic location. Referrals (pain clinic, orthopedics, neurology, rheumatology, or any of the above) were tracked through June 2024 and analyzed using Cox proportional hazard models. While some patients were referred to multiple specialists, each model included one observation per patient.

RESULTS

Of 777 patients with a chronic pain visit, 468 met eligibility criteria (pain occurring for greater than 3 months, without pain specialist visits in the last 12 months), among whom 17% were referred to a pain clinic, 26% to orthopedics, 6% to neurology, and 3% to rheumatology. Patients initially visiting rural (vs. urban) primary care clinics were less likely to be referred to a pain specialist (hazard ratio [HR]:0.51; p = 0.004) or rheumatology (HR:0.29; p = 0.027), but more likely to be referred to orthopedics (HR:1.54; p = 0.046).

CONCLUSIONS

Referral patterns for chronic pain differ between rural and urban primary care clinics, potentially influencing subsequent chronic pain management.