Pain management decisions in emergency hospitals are predicted by brain activity during empathy and error monitoring

Abstract

Objective: Pain undertreatment, or oligoanalgesia, is frequent in the emergency department (ED), with major medical, ethical, and financial implications. Across different hospitals, healthcare providers have been reported to differ considerably in the ways in which they recognise and manage pain, with some prescribing analgesics far less frequently than others. However, factors that could explain this variability remain poorly understood. Here, we used neuroscience approaches for neural signal modelling to investigate whether individual decisions in the ED could be explained in terms of brain patterns related to empathy, risk-taking, and error monitoring. Methods: For 15 months, we monitored the pain management behaviour of 70 ED nurses at triage, and subsequently invited 33 to a neuroimaging study involving three well-established tasks probing relevant cognitive and affective dimensions. Univariate and multivariate regressions were used to predict pain management decisions from neural activity during these tasks. Results: We found that the brain signal recorded when empathising with others predicted the frequency with which nurses documented pain in their patients. In addition, neural activity sensitive to errors and negative outcomes predicted the frequency with which nurses denied analgesia by registering potential side-effects. Conclusions: These results highlight the multiple processes underlying pain management, and suggest that the neural representations of others' states and one's errors play a key role in individual treatment decisions. Neuroscience models of social cognition and decision-making are a powerful tool to explain clinical behaviour and might be used to guide future educational programs to improve pain management in ED.

Medical education and distrust modulate the response of insular-cingulate network and ventral striatum in pain diagnosis

“…Concerns for such side-effects (e.g. opiophobia) contribute to inadequate pain treatment in medical settings ( Bennett and Carr, 2002 ; Bertrand et al, 2021 ; Corradi-Dell'Acqua et al, 2019 ), as healthcare providers prioritize those cases in which pain is unequivocally established. In this perspective, one study showed that doctors and nurses tended to underestimate pain in larger extent when presented with cues that patients might have lied or exaggerate their ratings ( Kappesser et al, 2006 ).…”

“…In clinical settings, acknowledging high levels of pain often leads to the prescription of strong analgesics, which however have contraindications for patients' health (Buckeridge et al, 2010;Butler et al, 2016;Makris et al, 2014). Concerns for such side-effects (e.g., opiophobia) contribute to inadequate pain treatment in medical settings (Bennett and Carr, 2002;Bertrand et al, 2021;Corradi-Dell'Acqua et al, 2019), as healthcare providers prioritize those cases in which pain is unequivocally established. In this perspective, one study showed that doctors and nurses tended to underestimate pain in larger extent when presented with cues that patients might have lied or exaggerate their ratings (Kappesser et al, 2006).…”

Progress in pain medicine: where are we now?

“…Empathy and risk taking were shown to be some of the factors impacting on how patients with pain were managed in the emergency department. 14 Management of patients with chronic non-malignant pain using long-term potent opioids has been the subject of much discussion, with concerns about increasing addiction and dependence rates, and the contribution that surgery may make to this problem. 15,16 The IASP has produced a position statement around the use of opioids for chronic pain, which reflects these concerns, although ensuring that continued, appropriate use of opioids in acute and cancer pain management is important, especially in lower-and middle-income countries.…”

Opiophobia in Emergency Department Healthcare Providers: A Survey in Western Switzerland

“…Our study shows an association between the SUS and the ATMS. Even though this association does not demonstrate a causal link nor is proof of a lower opioid prescription rate, we showed recently that nurses with a higher SUS were less likely to use a nurse-led pain protocol [ 29 ]. SUS may prove to be a new malleable target for educational interventions [ 30 ], and an innovative approach to reduce the burden of unrelieved pain.…”