Without medical evidence, clinicians' judgment about chronic pain is often influenced by patient and situational factors
Research Activities, October 2009
Clinicians are usually quite certain about the medical decisions necessary to treat acute pain. However, provider judgments become less clear when pain does not resolve or is chronic in nature.
In their review of studies of pain assessment, Raymond C. Tait, Ph.D., of Saint Louis University School of Medicine, and colleagues identified interpersonal and situational factors that can affect providers' judgments about pain. They found that several social factors influence judgments about symptom certainty. These include patient and provider characteristics related to the clinical encounter. Their influence is most profound when pain is severe and chronic. Examples of such factors are medical evidence; patient gender, minority status, and manner; and the provider's empathy level and experience treating pain.
According to the researchers, high levels of pain severity, especially in the absence of clear-cut medical evidence, consistently contribute to clinician uncertainty about the cause and treatment. In these cases, the patient's characteristics and situation affect the judgment process. For example, the clinician can be tempted to link worsened pain to some convenient patient factor, such as emotional distress or noncompliance with treatment. While intuitively appealing, these factors may have little association with pain severity and/or adjustment. However, high levels of provider empathy can offset the attribution of chronic pain to psychological distress, note the researchers. They propose a model for pain judgment that encourages clinicians to use as many sources of information as possible to inform their judgments about pain. This collective knowledge is likely to reduce symptom uncertainty.
In addition, psychological distress needs to be assessed, as it is often associated with chronic pain. Finally, providers should consider involving the patient's spouse/partner as an additional source of information for determining symptom certainty. The study was supported in part by the Agency for Healthcare Research and Quality (HS14007).
See "Provider judgments of patients in pain: Seeking symptom certainty," by Dr. Tait, John T. Chibnall, Ph.D., and Donna Kalauokalani, M.D., M.P.H., in 2009 Pain Medicine 10(1), pp. 11-34.