Accountability and empathy effects on medical students' clinical judgments in a disability determination context for low back pain

Prevalence and correlates of low back pain among undergraduate medical students in Serbia, a cross-sectional study

Background

Low back pain (LBP) is a serious health problem among medical students. We aimed to investigate the prevalence and associated factors for LBP among Serbian medical students.

Methods

A cross-sectional study was performed among medical students at one University in Serbia. Data was collected by a self-reported questionnaire. Logistic regression was used to determine the factors associated with LBP; results from the analyses were expressed as odds ratios (OR) with 95% confidence intervals (CI).

Results

The study sample comprised 499 medical students, giving a response rate of 92.9%. The mean age of the participants was 22.0 ± 2.2 years (range 18–34). Overall, 20.8% (104/499) of medical students had LBP at the time of study. Cigarette smoking (OR = 2.5, 95% CI [1.5–4.2], p = 0.001), stress during classes (OR = 1.8, 95% CI [1.1–3.0], p = 0.039), incorrect sleeping position (OR = 1.9, 95% CI [1.2–3.1], p = 0.006) and family history of LBP (OR = 1.6, 95% CI [1.1–2.7], p = 0.047) were independently associated with high prevalence of LBP at the time of the study.

Conclusions

LBP is a highly prevalent health problem in medical students in Serbia. The association between LBP and cigarette smoking, stress during classes, incorrect sleeping position and LBP in family history has been observed in medical students.

Knowledge of psychosocial factors associated with low back pain amongst health science students: a scoping review

Background

Low back pain is a burden worldwide and biological, psychological, and social mechanisms play a role in its development and persistence. Current guidelines support care using the biopsychosocial model. However, biomedical constructs dominate clinician training, and it is unknown the extent to which health science students understand the psychosocial determinates of a patient’s low back pain. Therefore, the aim of this scoping review is to report health science students’ current knowledge of psychosocial factors associated with low back pain.

Methods

A scoping review framework was used to search electronic databases for research examining health science students’ knowledge of psychosocial factors associated with low back pain. The nature and findings of the studies are highlighted using the data charting tool. Each study was analyzed to determine the type of outcome measurement used. Scores were compared to minimum accepted scores, between disciplines, as education advanced, and after educational modules.

Results

Fourteen studies published between 2004 and 2019 were identified. Seven healthcare disciplines were represented.

In total, 12 different measurement tools were utilized. In 9 studies students demonstrated inadequate knowledge of psychosocial factors associated with low back pain. Three tools compared disciplines and nationalities. Three tools were associated with practice behavior. Eight studies showed improvement as students’ education advanced, and 3 studies demonstrated improvements in knowledge after implementation of pain education modules of varied lengths. Of those, two showed significant improvement.

Conclusions

Health science students in these studies had substandard understanding of psychosocial factors associated with low back pain. Dedicated pain education has the potential to improve low back pain understanding, resulting in more guideline appropriate care recommendation.

Cognitive-behavioral therapy for patients with chronic pain: Implications of gender differences in empathy

Chronic pain is defined as persistent or recurrent pain lasting longer than 3 months; the severity of pain can be rated in terms of intensity, pain-related distress, and functional impairment. Researches have shown an association between psychosocial factors, such as empathic ability, and the severity of pain. Cognitive-behavioral therapy (CBT) is the most common psychologic intervention for individuals with chronic pain. The aim of this study was to investigate the effect of CBT on empathy in chronic pain patients, examining especially gender differences. In total, 89 patients with severe chronic pain (46 men and 43 women) underwent 8 sessions of CBT over the course of 4 weeks. Self-reported clinical symptoms were measured at the beginning and end of the CBT. Empathy was measured using the interpersonal reactivity index, and pain severity was assessed using the short-form McGill pain questionnaire. A comparison of male and female patients before CBT indicated that females showed higher levels of empathy in response to affective issues and reported greater affective pain than males. A mixed analysis of variance revealed that female patients showed higher levels of empathy than did male patients, both before and after CBT. We also found significant relationships between affective pain and empathy for others' personal distress in all patients. These results suggest that the effectiveness of CBT may be affected by chronic pain patients' level of empathy. Although the evident result was not shown in this study, the present findings imply that female patients may formulate excellent therapeutic alliance in CBT intervention that can lead to a clinical benefit.

Impaired Empathic Abilities among Patients with Complex Regional Pain Syndrome (Type I)

OBJECTIVE

The aims of this study were to evaluate differences in empathic abilities between patients with complex regional pain syndrome (CRPS) Type I and healthy control subjects (HCs) and to assess correlations between empathic abilities and multidimensional aspects of pain.

METHODS

Empathic ability was measured in 32 patients with CRPS Type I and in 36 HCs using the Interpersonal Reactivity Index (IRI). A comprehensive assessment of pain was conducted in the patient group using the West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Psychiatric symptoms were assessed using the Beck Depression and Anxiety Inventories (BDI and BAI), and quality of life was evaluated using the WHO Quality of Life (WHOQOL-BREF) questionnaire.

RESULTS

Patients with CRPS showed impaired cognitive and emotional empathic abilities compared with HCs. Significantly lower levels of perspective taking and empathic concern and higher levels of personal distress on the IRI were exhibited by the patient group. Perspective taking and personal distress were associated with affective distress and poor quality of life in social contexts (BDI, BAI, and WHOQOL). However, empathic concern was positively correlated with pain severity and social support from others (WHYMPI).

CONCLUSION

A tendency toward self-oriented distress in social cognition was exhibited among patients with CRPS Type I. Impaired empathic ability was shown to have potentially negative effects on subjective emotional outcomes and social performance in the lives of patients. Interventions to improve emotional awareness and theory of mind would be beneficial for enhancing social functioning in patients with CRPS Type I.

Medical Judgments Across the Range of Reported Pain Severity: Clinician and Lay Perspectives

BACKGROUND

While increasing evidence suggests that observers discount high-severity chronic pain, factors that occasion such discounting are poorly understood, particularly regarding health provider vs lay perspectives.

OBJECTIVE

This study examined the effects of supporting medical evidence and comorbid psychological distress (pain behavior) on medical student and lay clinical judgments of increasingly severe patient pain reports.

DESIGN

In a 2 × 2 × 2 × (7) mixed between- and within-subject design, participants (medical students vs lay) made clinical judgments after reading vignettes describing a hypothetical patient that varied in levels of medical evidence and pain behavior (low vs high) and pain severity (4/10-10/10).

SUBJECTS

Fourth-year medical students (N = 115) and lay persons in the community (N = 300) participated in this research.

RESULTS

While both medical student and lay judgments plateaued at high levels of pain severity, judgments regarding cause (medical vs psychological), treatment (opioid prescription), and disability showed growing divergence as levels of reported pain severity increased. Divergence relative to medical and psychological causes of pain was found irrespective of the level of supporting medical evidence; divergence relative to opioid treatment and support for a disability claim was found when supporting medical evidence was low.

CONCLUSIONS

The results indicate differing expectations of chronic pain treatment for health care providers relative to the lay public that could impact clinical care, especially at high pain severity levels, where lay expectations diverge significantly from those of health professionals.