No abstract

Complex factors influence how people report and interpret numerical pain ratings. Such variability can introduce noise and systematic bias into clinical pain assessment. Identification of factors that influence self-rated pain and its interpretation by others may bolster utility of these scales. In this qualitative study, 338 participants described motivations for modulating their own pain reports relative to a numerical pain scale (0–10), as well as perceptions of others’ pain reporting modulation. Responses indicated that people over-report pain to enhance provider belief/responsiveness or the likelihood of pain relief, and out of fear of future pain or potential illness. Concerns of how one’s pain affects and is perceived by others, and financial concerns motivated pain under-reporting. Unprompted, many participants reported never modulating their pain ratings, citing trust in providers and personal ethics. Similar reasons were assumed to motivate others’ pain ratings. However, participants often attributed others’ over-reporting to internal causes, and their own to external. This bias may underlie common assumptions that patients over-report pain for nefarious reasons, distort interpretation of pain reports, and contribute to pain invalidation. Recognition of patient concerns and one’s own personal biases toward others’ pain reporting may improve patient-provider trust and support precision of numerical pain ratings.

COVID-19 has come with widespread changes, adjustments, challenges and fears among healthcare providers of all kinds. Health Service Psychology (HSP) training sites across the nation have had to adjust to telepsychology services, some with prior experiences, and others for the first time. This article examines the perspectives of HSP doctoral trainees from one university across counseling, clinical, and school psychology trainees in terms of the adjustment to telepsychology services. Using an ecological approach, trainees were probed for personal and interpersonal components, attitudes toward telepsychology as well as reflections on clinic preparedness, supervision, and professional competency. The included responses may inform future direction of training sites, training rotations at healthcare settings, and implementation of telepsychology services. Public Significance StatementThis study focuses on the impact of the COVID-19 pandemic on the counseling services provided by health service psychology (HSP) doctoral students. Using an ecological framework, this study suggests that factors at the individual, interpersonal, community, organizational, and policy levels affected the rapid transition to telepsychology, and trainee readiness. Accordingly, there are several recommendations for improving preparedness of future trainees.

IntroductionLatinx-Americans are underserved across healthcare contexts, and racial disparities in pain management are pervasive. One potential contributor is racial bias in pain perception – including low-level implicit biases and explicitly held lay-beliefs. Delays in seeking pain treatment may compound these disparities. However, experiments testing these factors in the context of Latinx-American pain are limited, and mechanisms by which Latinx-American group-membership influences pain perception and treatment are not understood.MethodsHere, Latinx-American and White-American participants read vignettes including a Latinx or White patient’s pain description and numerical pain rating. Participants then rated how much pain they thought each patient was in using the same numerical scale. Participants also reported how much pain they themselves would need to experience to prompt treatment-seeking.ResultsIn contrast to prior work identifying lay beliefs that Latinx-Americans feel less pain than White-Americans, participants in the current study revealed a bias in the opposite direction. This was largely driven, however, by Latinx-American participants, who have been under-represented in previous studies of empathy and pain perception. Latinx-Americans ascribed more pain to patients overall – irrespective of patient race – relative to White-Americans. Latinx-American participants also reported that their own pain would need to be significantly more intense before seeing a doctor.ConclusionThese results suggest that, relative to White-Americans, Latinx-Americans may be more likely to believe people are in more pain than they report – or may be more perceptive of others’ pain – and that they may be in more pain upon presenting to medical settings.

Rewarding and aversive outcomes have opposing effects on behavior, facilitating approach and avoidance, although we need to accurately anticipate each type of outcome to behave effectively. Attention is biased toward stimuli that have been learned to predict either type of outcome, and it remains an open question whether such orienting is driven by separate systems for value- and threat-based orienting or whether there exists a common underlying mechanism of attentional control driven by motivational salience. Here, we provide a direct comparison of the neural correlates of value- and threat-based attentional capture after associative learning. Across multiple measures of behavior and brain activation, our findings overwhelmingly support a motivational salience account of the control of attention. We conclude that there exists a core mechanism of experience-dependent attentional control driven by motivational salience and that prior characterizations of attention as being value driven or supporting threat monitoring need to be revisited.