Discounting pain in the absence of medical evidence is explained by negative evaluation of the patient

Ruddere, Lies De; Goubert, Liesbet; Stevens, Michaël; Williams, Amanda C de C; Crombez, Geert

doi:10.1016/j.pain.2012.12.018

Cited by 89 publications

(79 citation statements)

References 43 publications

(60 reference statements)

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“…These results are in line with findings of several vignette studies indicating that the absence of medical evidence relates to lower pain estimates in lay observers 8,9,54 , medical students 10 , internal medicine physicians 55 and nurses. 57 Further, the results are consistent with recent findings 16,17 indicating that lay observers attribute lower pain, feel less sympathy for the patient, and are less inclined to help the patient when a medical explanation for the pain is lacking. Next, the results extend the findings of Taylor and colleagues 57 that show that nurses are less willing to undertake pain relief actions when medical evidence for pain is absent.…”

Section: Discussionsupporting

confidence: 88%

Health Care Professionals' Reactions to Patient Pain: Impact of Knowledge About Medical Evidence and Psychosocial Influences

Ruddere

Goubert

Stevens

et al. 2014

The Journal of Pain

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AND PERSPECTIVEThis study examined the impact of evidence concerning the presence of: a) a biomedical basis for pain, and b) psychosocial influences, on practitioner appraisals of patient pain experiences.Further, the potential moderating role of patient pain behaviour was examined. In an online study, 52 general practitioners (GPs) and 46 physiotherapists (PTs) viewed video sequences of 4 patients manifesting pain, with accompanying vignettes describing presence or absence of medical evidence and psychosocial influences. Participants estimated pain intensity, daily interference, felt sympathy, effectiveness of pain medication, self-efficacy, their likability and suspicions of deception. Primary findings indicated lower perceived pain and daily interference, less sympathy, lower expectations of medication impact, and less self-efficacy when medical evidence was absent. The same results were found when psychosocial influences were present, but only when the patient displayed higher levels of pain behavior.Further, absence of medical evidence was related to less positive evaluations of the patients and to higher beliefs in deception in both professions. The presence of psychosocial influences was related to less positive evaluations and higher beliefs in deception in both professions. In sum, a range of contextual factors influence healthcare practitioner responses to patient pain. Implications for caregiving behavior are discussed.Perspective: The present study indicates that in the absence of clear medical evidence and in the presence of psychosocial influences patient pain might be taken less seriously by healthcare practitioners. These findings are important to further understand the difficulties that relate to the clinical encounter between pain patients and healthcare practitioners.

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Section: Discussionsupporting

confidence: 88%

Health Care Professionals' Reactions to Patient Pain: Impact of Knowledge About Medical Evidence and Psychosocial Influences

Ruddere

Goubert

Stevens

et al. 2014

The Journal of Pain

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“…As we were interested in all included variables, fixed effects were never removed from the model. Finally, in the third step, we inspected the ANOVA table of the final model, and tested specific hypotheses about possible main effects or interactions (for a similar approach see [22][23][24]) (see Supplementary File 3, showing the ANOVA table of the final model).…”

Section: Analysesmentioning

confidence: 99%

Watching what’s coming near increases tactile sensitivity: An experimental investigation

Biest

Legrain

Paepe

et al. 2016

Behavioural Brain Research

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During medical examinations, doctors regularly investigate a patient's somatosensory system by approaching the patient with a medical device (e.g. Von Frey hairs, algometer) or with their hands. It is assumed that the obtained results reflect the true capacities of the somatosensory system. However, evidence from crossmodal spatial research suggests that sensory experiences in one modality (e.g. touch) can be influenced by concurrent information from other modalities (e.g. vision), especially near the body (i.e. in peripersonal space). Hence, we hypothesized that seeing someone approaching your body could alter tactile sensitivity in that body-part. In the In Vivo Approaching Object (IVAO) paradigm, participants detected and localized threshold-level vibrotactile stimuli administered on the left of right hand (= tactile targets). In Experiment 1, this was always preceded by the experimenter approaching the same (congruent trials) or the other (incongruent trials) hand with a pen (= visual cue). In Experiment 2, a condition was added in which a point further away from the hands (also left vs. right) was approached. Response Accuracy was calculated for congruent and incongruent trials (Experiment 1 & 2) and compared between the close and far condition (Experiment 2). As expected, Response Accuracy was higher in congruent trials compared to incongruent trials, but only near the body. As a result, evidence was found for a crossmodal interaction effect between visual and tactile information in peripersonal space. These results suggest that somatosensory evaluations -both medical or research-based -may be biased by viewing an object approaching the body.

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“…Even more, patients frequently report dissatisfaction with the provided care 41,53 and abundant research indicates that individuals with chronic pain might be prone to stigmatization by others. [17][18][19][20]30,32 Stigmatizing responses have been defined as 'devaluing and discrediting responses of observers towards individuals who possess a particular characteristic that deviates from societal norms' 14 . In the context of chronic pain, many individuals suffer from pain that is not clearly medically understood 29,34 .…”

Section: Introductionmentioning

confidence: 99%

“…Such absence of medical evidence can be considered as a deviation from the biomedical model, which is still widely endorsed in Western societies. 23 Accordingly, the absence of medical evidence has been related to lower pain estimates by observers, 7,8,[18][19][20]46,47 higher beliefs of deception, 18 and less sympathy and inclination to help. [18][19][20] As yet, there is no evidence that observers also socially exclude patients with medically unexplained pain.…”

Section: Introductionmentioning

confidence: 99%

“…By doing so, we tested the replicability and robustness of previous findings of De Ruddere and colleagues. [18][19][20] We hypothesized that observers would attribute less pain, report feeling less sympathy and being less inclined to help patients when there is no medical evidence for the pain compared to when there is medical evidence for the pain. A third aim relates to the moderating role of patient's pain behavior in the impact of presence versus absence of medical evidence upon observer responses (pain, sympathy and inclination to help).…”

Section: Introductionmentioning

confidence: 99%

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Patients Are Socially Excluded When Their Pain Has No Medical Explanation

Ruddere

Bosmans

Crombez

et al. 2016

The Journal of Pain

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This study investigated whether observers socially exclude patients who experience pain that is not medically explained by means of an experimental design. Fifty-nine participants (individuals from the general population) viewed videos of 4 patients, each accompanied by a vignette describing the presence or absence of a medical explanation for their pain. Participants estimated patient's pain, and rated the sympathy felt for and the inclination to help the patient.In order to measure social exclusion, participants indicated their willingness to interact with the patients in several situations (Social Distance Scale). Furthermore, the participants were invited to select two of the four patients as confederates to play a game against another duo. When no medical explanation for the pain was provided, participants attributed less pain, reported feeling less sympathy and were less inclined to help the patients with daily activities. Of particular importance to this study, participants were less willing to interact with patients with medically unexplained pain and selected less often patients with 'medically unexplained' pain than patients with 'medically explained' pain as confederates in the social game. These results are indicative of social exclusion of patients with pain for which there is no clear medical explanation.Perspective: Observers socially exclude patients with pain for which there is no clear medical explanation. These findings have important clinical implications. In particular, social exclusion might have detrimental effects on both the mental and physical wellbeing of patients with pain.

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Discounting pain in the absence of medical evidence is explained by negative evaluation of the patient

Cited by 89 publications

References 43 publications

Health Care Professionals' Reactions to Patient Pain: Impact of Knowledge About Medical Evidence and Psychosocial Influences

Health Care Professionals' Reactions to Patient Pain: Impact of Knowledge About Medical Evidence and Psychosocial Influences

Watching what’s coming near increases tactile sensitivity: An experimental investigation

Patients Are Socially Excluded When Their Pain Has No Medical Explanation

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