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

Abstract

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.

Patients Are Socially Excluded When Their Pain Has No Medical Explanation

“…In line with the results of our study, individuals from the general population as well as healthcare professionals attribute lower pain to patients with unexplained pain, 7,8,[18][19][20]46,47 feel less sympathy for these patients and are less inclined to help them. [18][19][20] Patients also report to experience stigmatizing responses. In the study of Kool and colleagues, 33 individuals with fibromyalgia (i.e., an illness that is characterized by widespread pain that is not medically understood) experienced more discounting responses by others than individuals with rheumatoid arthritis (i.e., an illness that is characterized by widespread pain that is well understood medically).…”

“…The presence (arthritis or a compressed nerve in the back) versus absence of medical evidence for the pain was manipulated in the vignettes (see also De Ruddere and colleagues 19 ). Each vignette also contained information on patient's name, age, profession, and number of children in order to make the pictures and video sequences of the patients more vivid/realistic for the participants.…”

“…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 .…”

“…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.…”

“…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).…”