How and Why Patient Concerns Influence Pain Reporting: A Qualitative Analysis of Personal Accounts and Perceptions of Others’ Use of Numerical Pain Scales

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.

Over-Rating Pain is Overrated: A Fundamental Self-Other Bias in Pain Reporting Behavior

“…2,45,54 We recently reported qualitative findings from the present sample that clarify this bias, indicating that over-reporting of pain by others is more-likely to be attributed to ulterior motives or character deficiencies whereas motives for ever over-reporting themselves were influenced by external and situational factors (ie, to ensure treatment or protect the self from further mental or physical harm). 5 Taken together with the current quantitative findings, this suggests that psychological processes of behavior assessment such as the fundamental attribution error influence − and are influenced by − more widely-held cultural perceptions of pain experiences, warranting future exploration of psychological factors that contribute to societal norms, beliefs, and stigma related to pain. 44 Our results also highlight patterns of behavior by people with minoritized identities (ie, women and Latinx Americans) that are likely responsive to, and reflective of, encounters with discriminatory treatment.…”

“…Participants then answered open ended questions about pain reporting (qualitative results reported elsewhere), 5 and then completed additional questions to provide pilot data for future work. Finally, participants provided demographic information (age and self-identified gender and racialized identities) and were then debriefed.…”

Shame Mediates the Relationship Between Pain Invalidation and Depression

“…In addition, qualitative research indicates that experiences of pain invalidation evoke experiences of stigmatization – a societal judgment that enforces shame – and other constructs that are closely tied to shame, such as lower self-worth and social withdrawal ( Asbring and Närvänen, 2002 ; Jones et al, 2004 ; Drossman et al, 2009 ; Oehmke et al, 2009 ; Nicola et al, 2019 , 2021 ). Further support for the relationship between pain invalidation, shame, and depression comes from qualitative research indicating people often feel shame and shame-related constructs, such as self-consciousness, due to the experience of pain itself (regardless of exposure to invalidation) and that illness invalidation broadly is associated with depression ( Osborn and Smith, 1998 ; Smith and Osborn, 2007 ; Sehlo et al, 2016 ; Boring et al, 2021 ). However, no studies have examined shame and depression together directly in relation to pain invalidation.…”

Health‐related quality of life of female sex workers living with HIV in South Africa: a cross‐sectional study

“…Moreover, HRQoL score is calculated by valuing individual's self‐rated health state from a wider population's perspective of health preference, which contrasts with EQ‐VAS, reflecting purely individual's subjective perception of health [16]. Other reasons underlying the non‐monotonic relationship (although not statistically significant) between stigma and self‐reported problems on the EQ‐5D domains may include the following: stigma may be associated with individual's definition/perception of “having a problem”/tolerance levels of the problem [35]; as well as individual's tendency to provide socially desirable answers [36]. Future studies using disease‐specific HRQoL measures, such as the WHOQOL‐HIV BREF [33], and exploring various underlying types of stigma [37] may provide additional insights into the relationship between stigma and HRQoL among FSW living with HIV.…”