Healthcare Providers’ Nonverbal Behavior can Lead Patients to Show Their Pain More Accurately: An Analogue Study

Abstract

Accurate pain assessment is a joint function of both the judge perceiving correct (valid) cues of pain and targets displaying valid indicators of pain. The present research examined whether the judgeability of pain expressions could be altered by manipulating the nonverbal supportiveness of a videotaped physician who guided targets through an experimentally induced pain experience in the laboratory. Ten-s video clips of these targets during their pain experience were viewed by 95 naïve judges who assessed each target's pain on an 11-point numeric rating scale. In addition, the video clips were rated by independent coders on 9-point scales (focused, calm, tense, distressed, composed, fidgety, determined, bored, and nervous). Judges' pain assessment accuracy was calculated by correlating their inferred pain rating for each target with targets' self-reported pain. Pain targets assigned to interact with the nonverbally supportive physician displayed more valid impressions of their pain and judges had higher pain assessment accuracy when viewing these targets compared to targets assigned to interact with the nonverbally unsupportive physician. Interventions for caregivers and healthcare providers that emphasize the importance of nonverbal behavior when interacting with pain sufferers are discussed.

A Qualitative Systematic Review of Effects of Provider Characteristics and Nonverbal Behavior on Pain, and Placebo and Nocebo Effects

“…In sum, six of seven studies concluded that positive NBs of experimenters/clinicians resulted in lower pain reports (64, 67, 70, 71), more accurate pain ratings (69), and less narcotic use and better physical and emotional state (46), whereas negative NBs led to higher pain reports and lower pain tolerance (67, 70, 71). On the other hand, one study failed to find a significant effect of experimenters/clinicians NB (66) ( Table 3 ).…”

“…Seven studies investigated the effects of experimenters/clinicians NBs on the pain of research participants: Ruben et al (70) showed that, compared to clinicians with negative NBs, clinicians with positive NBs induced higher pain tolerance and less pain expressions. In another study, Ruben and colleagues (69) showed that clinicians with positive NBs generated more accurate pain ratings (i.e., consistency between expressions of pain by subjects and judgments about pain ratings by observers), compared to clinicians with negative NBs. Czerniak et al (71) showed that a clinician with restricted movements, minimal eye contact, more typing, and lack of tactile interaction such as shaking hands induced lower pain thresholds in participants.…”

“…As there can be uncertainty about the outcome of interventions (54, 85), participants/patients might use as much of accessible information as possible to gain knowledge about the efficacy of the intervention. NBs of experimenters/clinicians can be a substantial source of information for participants/patients (36, 69, 70). In this line, Ambady and Gray (40) showed that positive NBs of clinicians (e.g., facial expressiveness, nodding, and smiling) were associated with long-term improvements in cognitive and physical functioning of elderly patients.…”

Chinese patients’ response to doctor–patient relationship stimuli: evidence from an event-related potential study

“…From media coverage, doctor–patient conflicts are more likely to be reported than positive events, suggesting that patients often come into contact with information about negative doctor–patient relationships [ 57 ]. However, for the stimuli of positive doctor–patient relationships, their elements could make the patient feel psychologically satisfied (e.g., the doctor’s concern for the patient; [ 40 ],therefore, the reason for this discrepancy might be that individuals paid increased attention to a positive doctor–patient relationship (Fig. 2 ).…”