Pain judgements of patients’ relatives: examining the use of social contract theory as theoretical framework

How do the activity patterns of people with chronic pain influence the empathic response of future health professionals: an experimental study

Empathy in healthcare professionals is associated with better treatment outcomes and higher satisfaction among patients with chronic pain. Activity patterns play an essential role in the adjustment of these patients and, as a pain behaviour, may have a communicative function and elicit distinct empathic responses. This study investigated whether the activity pattern profiles characteristic of these patients had differential effects on the empathic response (empathic distress and compassion/sympathy) of future healthcare professionals. Healthcare professionals should improve their knowledge about the role of different activity patterns in the well-being of people with chronic pain and receive specific training in empathic skills. We controlled for several variables that could affect the empathic response (sex, age, academic degree, previous experience of chronic pain, and dispositional empathy).A total of 228 undergraduates performed an experimental task using vignettes depicting four activity pattern profiles displayed by people with chronic pain and completed questionnaires measuring dispositional and situational empathy. We conducted a MANCOVA analysis.Undergraduates showed more compassion/sympathy toward the medium cycler profile than toward the doer profile. Participants' age was associated with empathic distress. Sex, academic degree, and previous experiences with chronic pain were not associated with their empathic response to the vignettes. Dispositional perspective-taking and empathic concern were significantly associated with compassion/sympathy responses, and personal distress was significantly associated with empathic distress.Activity pattern profiles may have a communicative function and elicit different empathic responses toward people with chronic pain. Individual differences in dispositional empathy play an important role on situational empathic responses.

Reframing pain: the power of individual and societal factors to enhance pain treatment

The effectiveness of analgesics can be increased if synergistic behavioural, psychological, and pharmacological interventions are provided within a supportive environment.

Criminality labelling influences reactions to others' pain

Disparities in healthcare for underrepresented and stigmatized groups are well documented. Current understanding is that these inequalities arise, at least in part, from psychosocial factors such as stereotypes and in-group/out-group categorization. Pain management, perhaps because of the subjective nature of pain, is one area of research that has spearheaded these efforts. We investigated how observers react to the pain of individuals labelled as criminals. Face models expressing pain of different levels of intensity were portrayed as having committed a crime or not (control group). A sample of n = 327 college students were asked to estimate the intensity of the pain expressed by face models as well as their willingness to help them. Trait empathy was also measured. Data was analyzed using regression, mediation and moderation analyses. We show for the first time that observers were less willing to help individuals with a criminal history. Moreover, a moderation effect was observed whereby empathic participants were more willing to help control face models compared to less empathic participants. However, criminality history did not influence participant's pain estimation. We conclude that negative stereotypes associated with criminality can reduce willingness to help individuals in pain even when pain signals are accurately perceived.

The Time Course of Facial Expression Recognition Using Spatial Frequency Information: Comparing Pain and Core Emotions

We are able to recognize others' experience of pain from their facial expressions. However, little is known about what makes the recognition of pain possible and whether it is similar or different from core emotions. This study investigated the mechanisms underpinning the recognition of pain expressions, in terms of spatial frequency (SF) information analysis, and compared pain with 2 core emotions (ie, fear and happiness). Two experiments using a backward masking paradigm were conducted to examine the time course of low- and high-SF information processing, by manipulating the presentation duration of face stimuli and target-mask onset asynchrony. Overall, we found a temporal advantage of low-SF over high-SF information for expression recognition, including pain. This asynchrony between low- and high-SF happened at a very early stage of information extraction, which indicates that the decoding of low-SF expression information is not only faster but possibly occurs before the processing of high-SF information. Interestingly, the recognition of pain was also found to be slower and more difficult than core emotions. It is suggested that more complex decoding process may be involved in the successful recognition of pain from facial expressions, possibly due to the multidimensional nature of pain experiences. PERSPECTIVE: Two studies explore the perceptual and temporal properties of the decoding of pain facial expressions. At very early stages of attention, the recognition of pain was found to be more difficult than fear and happiness. It suggests that pain is a complex expression, and requires additional time to detect and process.

The facial expression of pain in humans considered from a social perspective

The social modulation of pain in humans has been neglected so far with respect to verbal as well as non-verbal communication of pain. The facial pain expression is a powerful way to communicate pain, and there are some theoretical accounts available on how social modulation may affect the encoding of the facial expression of pain. Some accounts, particularly in the pain field, are proximate explanations on the mechanisms involved, whereas an evolutionary psychology account takes a more comprehensive approach. A review of nine experimental studies revealed that in the majority of studies (6/9), social context had an effect on the facial pain expression, but results were inconsistent. Several conceptual and methodological issues are discussed which may explain these inconsistencies and could help in design of future experimental studies. This article is part of the Theo Murphy meeting issue 'Evolution of mechanisms and behaviour important for pain'.

Strategies for Pain Assessment in Adult Patients With Delirium: A Scoping Review

CONTEXT

Pain and delirium are highly prevalent in the same patient groups. Disturbances in attention, awareness, and cognition are characteristics for delirium and can compromise pain assessment.

OBJECTIVES

The aim of this review was to examine and map models and understandings of pain and delirium as well as pain assessment instruments and strategies for adult patients with delirium.

METHODS

A scoping review of all publications that reported on pain assessment in adult patients with delirium was conducted with no time and language constraints, searching Medline, CINAHL, Scopus, Embase, and PsycINFO and systematically assessing for inclusion. Standardized data extraction and a narrative synthesis followed.

RESULTS

A total of 90 publications were included in the final analysis. Despite being recommended for practice, no evidence for the use of self-report or behavioral pain assessment instruments in patients with delirium was identified, with the exception of limited evidence for the validity of the Critical Care Pain Observation Tool and Behavioral Pain Scale in delirious intensive care patients. Proxy ratings of pain and comprehensive pain assessment hierarchies were also recommended, but not supported by evidence. Current models and/or understandings of pain and delirium were not applied in most publications.

CONCLUSION

The current literature is insufficient to guide clinical practice in pain assessment in patients with delirium. Future research will be needed to address the validity of existing pain assessment instruments, apply theoretical and conceptual understandings of pain and delirium, and build on prior studies to close evidence gaps.

Hide Your Pain: Social Threat Increases Pain Reports and Aggression, but Reduces Facial Pain Expression and Empathy

Earlier research studying the effects of social threat on the experience and expression of pain led to mixed results. In this study, female participants (N = 32) came to the lab with 2 confederates. Both confederates administered a total of 10 painful electrocutaneous stimuli to the participant. The framing of the administration was manipulated in a within-subjects design: In the low social threat condition the participant was told that the confederate could choose between 10 and 20 pain stimuli, thus they believed that this confederate chose to administer the minimum allowed number of pain stimuli. In the high social threat condition the confederate had a choice between 1 and 10 stimuli, thus they believed that this confederate chose to administer the maximum allowed number of stimuli. Participants reported on the intensity, unpleasantness, and threat value of the painful stimuli, and their facial expression was recorded. Moreover, aggression and empathy toward the confederates were assessed. As hypothesized, participants reported increased pain intensity, unpleasantness, and threat in the high social threat condition compared to the low social threat condition, but showed less facial pain expression. Finally, participants exhibited increased aggression and reduced empathy toward the confederate in the high social threat condition. PERSPECTIVE: Social threat reduces painful facial expression, but simultaneously increases pain reports, leading to a double burden of the person in pain. Additionally, social threat affected social relationships by increasing aggression and reducing empathy for the other.

The pain of being misunderstood: Invalidation of pain complaints in chronic low back pain patients

A particular form of social pain is invalidation. Therefore, this study (a) investigates whether patients with chronic low back pain experience invalidation, (b) if it has an influence on their pain, and (c) explores whether various social sources (e.g. partner and work) influence physical pain differentially. A total of 92 patients completed questionnaires, and for analysis, Pearson’s correlation coefficients and hierarchical linear regression analyses were conducted. They indicated a significant association between discounting and disability due to pain (respective β = .29, p > .05). Especially, discounting by partner was linked to higher disability ( β = .28, p > .05).

The influence of contextual variables on judgments about patients and their pain

OBJECTIVE

Professional judgments about persistent pain are influenced by contextual variables, which are features relating to the patient, the assessor, or the broader situation. Such judgments directly inform assessment and treatment and therefore represent an important area of research. While current formulations of persistent pain adopt a biopsychosocial framework, contextual variables relating to psychosocial information have not been well examined in the literature.

DESIGN

We employed a within-subjects experimental vignette paradigm to investigate the influence of four contextual variables, 2 (medical evidence: present vs absent) × 2 (pain behavior: present vs absent) × 2 (referral to a psychologist: yes vs no) × 2 (responsibility: onset controllable vs onset uncontrollable), on perceptions of pain. Judgments about patients with chronic low back pain were made across several dimensions.

SUBJECTS

One hundred sixteen medical and nursing students.

RESULTS

Main findings revealed that identifiable pain pathology led to increased ratings of pain intensity and emotional distress, and decreased perceived likelihood of malingering. Pain behavior and referral to a psychologist were also found to increase ratings of pain intensity and emotional distress. Encouragingly, psychological referral was not found to increase the perceived likelihood of malingering. Responsibility for the initial injury was found to influence judgments, but this occurred in interaction with medical evidence as well as pain behavior.

CONCLUSIONS

These findings suggest that contextual variables have an important influence on medical and nursing students' perceptions of patients and their pain. Theoretical and practical implications for provider training and community education are discussed.

Perceived entitlement to pain-related support and pain catastrophizing: associations with perceived and observed support

Studies on the determinants of pain-related support are needed to enhance couples-based treatments for pain. The purpose of this study was to determine the extent to which pain catastrophizing and perceived entitlement to pain-related support (i.e., support entitlement) were associated with perceived and observed social support. Participants were 106 chronic pain couples recruited from the community. They completed surveys as well as an observational discussion task. Greater support entitlement in persons with pain was correlated positively with pain catastrophizing, punishing spouse responses, and observed spousal invalidation but negatively correlated with perceived spousal support, solicitous spouse responses, and observed validation. Catastrophizing was correlated with perceptions of general spousal support but not the other support variables. Hierarchical regression analyses demonstrated that among persons with lower levels of support entitlement, catastrophizing was associated with greater solicitous spouse responses. Among those with a greater entitlement to support, catastrophizing was associated with greater punishing spouse responses and observed invalidation by the spouse. These results suggest that support entitlement plays an important role in couples' supportive interactions about pain. Continued research is needed to determine how a desire for pain-related attention and support and catastrophizing translate into behaviors that affect support provision and receipt.