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He Y, Ge L, Yuan J, Wang Y, Zheng D, Rui A, Song J, Hu L, Wei GX. Interoceptive awareness mediated the effects of a 15-minute diaphragmatic breathing on empathy for pain: A randomized controlled trial. Psychophysiology 2024; 61:e14573. [PMID: 38530127 DOI: 10.1111/psyp.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 03/27/2024]
Abstract
Although empathy for pain plays an important role in positive interpersonal relationships and encourages engagement in prosocial behavior, it remains largely unknown whether empathy for pain could be effectively altered by psychophysiological techniques. This study aimed to investigate the impact of a single session of diaphragmatic breathing practice on empathy for pain and examine the potential mechanism involving interoceptive awareness. A total of 66 healthy participants were randomly assigned to the intervention group or the control group. The intervention group received a 15-minute diaphragmatic breathing (DB) practice with real-time biofeedback, while the control group was to gaze at a black screen at rest and not engaged in any other activities. Before and after the invention, all participants were instructed to evaluate the intensity and unpleasantness of empathy for pain while watching different pictures with pain or non-pain conditions. The Multidimensional Assessment of Interoceptive Awareness (MAIA) was then administered to measure interoceptive awareness. The results indicated a significant interaction between group and time with regard to empathy for pain and MAIA. The DB group showed a statistically significant decrease in both pain intensity and unpleasantness during the pain picture condition, as well as a noteworthy increase in MAIA scores. The control group did not demonstrate any substantial changes. More importantly, the regulation of attention, a dimension of MAIA, had a significant mediating effect on the impact of diaphragmatic breathing on reported unpleasantness. Diaphragmatic breathing could serve as a simple, convenient, and practical strategy to optimize human empathy for pain that warrants further investigation, which has important implications not only for individuals with impaired empathy for pain but also for the improvement of interoceptive awareness.
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Affiliation(s)
- Yaping He
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Likun Ge
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jiajin Yuan
- Sichuan Key Laboratory of Psychology and Behavior of Discipline Inspection and Supervision, Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Yingying Wang
- School of Psychology, Beijing Sport University, Beijing, China
| | - Danni Zheng
- School of Psychology, Beijing Sport University, Beijing, China
| | - An Rui
- School of Psychology, Beijing Sport University, Beijing, China
| | - Jun Song
- Experimental Research Center of China Academy of Chinese Medical Sciences, National Chinese Medicine Experts Inheritance Office, Beijing, China
| | - Li Hu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Gao-Xia Wei
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Schmidt L, Zabelberg S, Schlatter S, Adams I, Douplat M, Perchet C, Lilot M, Rey AE, Mazza S. The impact of shift work on pain recognition, a robust ability among intensive care nurses. Eur J Pain 2023; 27:1203-1215. [PMID: 37434490 DOI: 10.1002/ejp.2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Pain empathy is essential for high-quality of care. The cognitive ability to identify and understand the pain in others remains underexplored in the context of hospital shift work. This study aimed to observe the early subliminal ability to detect pain in other faces and to investigate pain intensity evaluations during day and night shifts. METHODS Twenty-one nurses (31 ± 7 years, 20 women) from cardio-paediatric intensive care participated in this study. Eighteen nurses completed all testing in the morning and evening hours, before and after the 12-hour day and night shift. In the first test, the nurses had to decide if facial stimuli presented subliminally showed pain or not. During the second test, they consciously determined the intensity of the painful faces on a numerical scale. Sleep, sleepiness and empathy were also measured. RESULTS Recognition accuracy and pain sensitivity remained stable over time, only sensitivity increased following the work shift (F(1,15) = 7.10, p = 0.018). Intensity ratings remained stable. Sleepiness at the end of the night shift was negatively correlated with accuracy (ρ = -0.51, p = 0.018) and positively correlated with prior night shifts (ρ = -0.50, p = 0.022). CONCLUSION The judgement of facial pain expressions seems robust across shift types, only individual factors such as sleepiness interfere with pain recognition. Pain sensitivity may be enhanced during working hours. SIGNIFICANCE STATEMENT Some professions need to know how to assess pain 24/7 and a lack of sleep can disrupt the cognitive processes necessary for this assessment. Night shifts provoke a bias in pain management, and sleep deprivation, a decrease in pain evaluation. By conducting a repeated measure study in the field that applied a different paradigm (subliminal recognition of facial cues) we add evidence to the understanding of pain recognition and the impact of sleep deprivation on the early processing of pain in others.
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Affiliation(s)
- Laura Schmidt
- Université Claude Bernard Lyon 1, Research on Healthcare Performance RESHAPE, INSERM U1290, Lyon, France
| | | | - Sophie Schlatter
- Université Claude Bernard Lyon 1, Research on Healthcare Performance RESHAPE, INSERM U1290, Lyon, France
- Université Claude Bernard Lyon 1, Centre Lyonnais d'enseignement par la simulation en Santé, CLESS, SimuLyon, Lyon, France
| | - Inga Adams
- Universität zu Köln, Psychologie, Cologne, Germany
| | - Marion Douplat
- Hospices Civils de Lyon, Département des Urgences, Hôpital Lyon Sud, Lyon, France
| | - Caroline Perchet
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, FORGETTING, F-69500, Bron, France
| | - Marc Lilot
- Université Claude Bernard Lyon 1, Research on Healthcare Performance RESHAPE, INSERM U1290, Lyon, France
- Université Claude Bernard Lyon 1, Centre Lyonnais d'enseignement par la simulation en Santé, CLESS, SimuLyon, Lyon, France
- Hospices Civils de Lyon, Département d'Anesthésie-Réanimation, Hôpital Louis Pradel, Groupement Hospitalier Est, Lyon, France
| | - Amandine Eve Rey
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, FORGETTING, F-69500, Bron, France
| | - Stéphanie Mazza
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, FORGETTING, F-69500, Bron, France
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Licciardone JC, Kellerlee J, Joseph M, Mohammad MB, Kim KG, Jain J, Aryal S. The process and outcomes of chronic low back pain treatment provided by osteopathic and allopathic physicians: a retrospective cohort study. J Osteopath Med 2023; 123:385-394. [PMID: 37225662 DOI: 10.1515/jom-2023-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/02/2023] [Indexed: 05/26/2023]
Abstract
CONTEXT Osteopathic physicians are trained to treat patients with musculoskeletal symptoms, to treat somatic dysfunction with osteopathic manipulative treatment (OMT), and to avoid unnecessarily prescribing drugs such as opioids. It is also generally believed that osteopathic physicians provide a unique patient-centered approach to medical care that involves effective communication and empathy. Such training and characteristics of osteopathic medical care (OMC) may enhance clinical outcomes among patients with chronic pain. OBJECTIVES The objectives of this study were to measure and compare the process and longitudinal outcomes of chronic low back pain (CLBP) treatment provided by osteopathic and allopathic physicians and to identify mediators of the treatment effects of OMC. METHODS This retrospective cohort study was conducted utilizing adult participants with CLBP within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) from April 2016 through December 2022. Participants having an osteopathic or allopathic physician for at least 1 month prior to registry enrollment were included and followed at quarterly intervals for up to 12 months. Physician communication and physician empathy were measured at registry enrollment. Opioid prescribing and effectiveness and safety outcomes were measured at registry enrollment and for up to 12 months and were analyzed with generalized estimating equations to compare participants treated by osteopathic vs. allopathic physicians. Multiple mediator models, including physician communication, physician empathy, opioid prescribing, and OMT, with covariate adjustments, were utilized to identify mediators of OMC treatment effects. RESULTS A total of 1,079 participants and 4,779 registry encounters were studied. The mean (SD) age of participants at enrollment was 52.9 (13.2) years, 796 (73.8 %) were female, and 167 (15.5 %) reported having an osteopathic physician. The mean physician communication score for osteopathic physicians was 71.2 (95 % CI, 67.6-74.7) vs. 66.2 (95 % CI, 64.8-67.7) for allopathic physicians (p=0.01). The respective mean scores for physician empathy were 41.6 (95 % CI, 39.9-43.2) vs. 38.3 (95 % CI, 37.6-39.1) (p<0.001). There was no significant difference in opioid prescribing for low back pain between osteopathic and allopathic physicians. Although participants treated by osteopathic physicians reported less severe nausea and vomiting as adverse events potentially attributable to opioids in a multivariable model, neither result was clinically relevant. OMC was associated with statistically significant and clinically relevant outcomes pertaining to low back pain intensity, physical function, and health-related quality of life (HRQOL) over 12 months. Physician empathy was a significant mediator of OMC treatment effects in each of the three outcome domains; however, physician communication, opioid prescribing, and OMT were not mediators. CONCLUSIONS The study findings indicate that osteopathic physicians provide a patient-centered approach to CLBP treatment, particularly involving empathy, that yields significant and clinically relevant outcomes pertaining to low back pain intensity, physical function, and HRQOL over 12 months of follow-up.
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Affiliation(s)
- John C Licciardone
- The Osteopathic Research Center and Department of Family Medicine, University of North Texas Health Science Center-Texas College of Osteopathic Medicine, Fort Worth, TX, USA
| | - Joel Kellerlee
- University of North Texas Health Science Center-Texas College of Osteopathic Medicine, Fort Worth, TX, USA
| | - Matthew Joseph
- University of North Texas Health Science Center-Texas College of Osteopathic Medicine, Fort Worth, TX, USA
| | - Moath B Mohammad
- University of North Texas Health Science Center-Texas College of Osteopathic Medicine, Fort Worth, TX, USA
| | - Kelly G Kim
- University of North Texas Health Science Center-Texas College of Osteopathic Medicine, Fort Worth, TX, USA
| | - Jyotirmaya Jain
- University of North Texas Health Science Center-Texas College of Osteopathic Medicine, Fort Worth, TX, USA
| | - Subhash Aryal
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Alshammari HS, Alshammari AS, Alshammari SA, Ahamed SS. Prevalence of Chronic Pain After Spinal Surgery: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e41841. [PMID: 37575867 PMCID: PMC10423077 DOI: 10.7759/cureus.41841] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Degenerative disc disease and low back pain are common challenges that persist even after a discectomy. However, characterizations and quantifications of these illnesses from the patients' perspective are insufficient. We aimed to perform a systematic review of the literature and meta-analysis to determine the frequency of chronic pain after spinal surgery. We searched MEDLINE (PubMed), Google Scholar, and the Saudi Digital Library to retrieve research articles describing the frequency of persistent back pain, reoccurring disc herniation, and undergoing another operation following primary lumbar discectomy. We excluded articles that did not disclose the proportion of patients who experienced ongoing back or leg pain for over six months after the operation. We included 16 studies evaluating 85,643 patients. The pooled prevalence of persistent pain was 14.97% (95% confidence interval: 12.38-17.76). With all advancements in technology and operation techniques, many patients (14.97%) still have failed back surgery syndrome. Appropriate preoperative communication and multidisciplinary and coordinated treatment strategies yielded the best results.
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Affiliation(s)
- Hotoon S Alshammari
- College of Medicine, King Saud University, Riyadh, SAU
- College of Medicine, AlMaarefa University, Riyadh, SAU
| | | | - Sulaiman A Alshammari
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, SAU
| | - Shaik Shaffi Ahamed
- Department of Family and Community Medicine (Biostatistics), College of Medicine, King Saud University, Riyadh, SAU
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Roberts-West L, Gravatt A, Guest N, Hunt A, Siddique L, Serbic D. A Comparison of Social Exclusion Towards People with Depression or Chronic Back Pain. Br J Pain 2023; 17:267-280. [PMID: 37342396 PMCID: PMC10278445 DOI: 10.1177/20494637221148337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Objectives Research comparing mental and physical health stigma is scarce. The aim of this study was to compare social exclusion towards hypothetical males and females with depression or chronic back pain. Furthermore, the study investigated whether social exclusion is associated with participant's empathy and personality traits, while controlling for their sex, age and personal exposure to mental/physical chronic health conditions. Design This study employed a cross-sectional questionnaire design. Methods Participants (N = 253) completed an online vignette-based questionnaire and were randomly allocated to either a depression or chronic back pain study condition. Measures of social exclusion through respondents' willingness to interact with hypothetical individuals, empathy and the Big Five personality traits were completed. Results Willingness to interact scores did not significantly differ depending on the diagnosis or sex of the hypothetical person in the vignette. For depression, higher levels of conscientiousness significantly predicted less willingness to interact. Whilst being a female participant and having higher empathy significantly predicted greater willingness to interact. For chronic back pain, higher empathy significantly predicted greater willingness to interact, with no significant predictors found from the Big Five personality traits. Conclusion Findings indicate that females and males with depression or chronic back pain face similar levels of social exclusion, with empathy being a core variable driving social exclusion behaviours. These findings enhance our understanding of potential variables driving social exclusion, in-turn informing campaign development to reduce public stigma towards depression and chronic back pain.
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Affiliation(s)
- Lucy Roberts-West
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| | - Amy Gravatt
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| | - Natasha Guest
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| | - Ashley Hunt
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| | - Laraib Siddique
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| | - Danijela Serbic
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
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Huang CW, Wu BCY, Nguyen PA, Wang HH, Kao CC, Lee PC, Rahmanti AR, Hsu JC, Yang HC, Li YCJ. Emotion recognition in doctor-patient interactions from real-world clinical video database: Initial development of artificial empathy. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 233:107480. [PMID: 36965299 DOI: 10.1016/j.cmpb.2023.107480] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/28/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE The promising use of artificial intelligence (AI) to emulate human empathy may help a physician engage with a more empathic doctor-patient relationship. This study demonstrates the application of artificial empathy based on facial emotion recognition to evaluate doctor-patient relationships in clinical practice. METHODS A prospective study used recorded video data of doctor-patient clinical encounters in dermatology outpatient clinics, Taipei Municipal Wanfang Hospital, and Taipei Medical University Hospital collected from March to December 2019. Two cameras recorded the facial expressions of four doctors and 348 adult patients during regular clinical practice. Facial emotion recognition was used to analyze the basic emotions of doctors and patients with a temporal resolution of 1 second. In addition, a physician-patient satisfaction questionnaire was administered after each clinical session, and two standard patients gave impartial feedback to avoid bias. RESULTS Data from 326 clinical session videos showed that (1) Doctors expressed more emotions than patients (t [326] > = 2.998, p < = 0.003), including anger, happiness, disgust, and sadness; the only emotion that patients showed more than doctors was surprise (t [326] = -4.428, p < .001) (p < .001). (2) Patients felt happier during the latter half of the session (t [326] = -2.860, p = .005), indicating a good doctor-patient relationship. CONCLUSIONS Artificial empathy can offer objective observations on how doctors' and patients' emotions change. With the ability to detect emotions in 3/4 view and profile images, artificial empathy could be an accessible evaluation tool to study doctor-patient relationships in practical clinical settings.
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Affiliation(s)
- Chih-Wei Huang
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Taipei Medical University Ringgold standard institution - Center for Simulation in Medical Education, Taipei 116, Taiwan
| | - Bethany C Y Wu
- National Taiwan University Children and Family Research Center Sponsored by CTBC Charity Foundation, Taipei, Taiwan
| | - Phung Anh Nguyen
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan; Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsiao-Han Wang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, TMU Da'an Campus 15 F, No. 172-1, Kee lung Road, Section 2, Da-an District, Taipei, Taiwan; Research Center of Big Data and Meta-analysis, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Dermatology, Wanfang Hospital, Taipei Medical University, Taiwan; Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Pei-Chen Lee
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
| | - Annisa Ristya Rahmanti
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, TMU Da'an Campus 15 F, No. 172-1, Kee lung Road, Section 2, Da-an District, Taipei, Taiwan; Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jason C Hsu
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan; International PhD Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan; Research Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Hsuan-Chia Yang
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, TMU Da'an Campus 15 F, No. 172-1, Kee lung Road, Section 2, Da-an District, Taipei, Taiwan; Research Center of Big Data and Meta-analysis, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Yu-Chuan Jack Li
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, TMU Da'an Campus 15 F, No. 172-1, Kee lung Road, Section 2, Da-an District, Taipei, Taiwan; Research Center of Big Data and Meta-analysis, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Dermatology, Wanfang Hospital, Taipei Medical University, Taiwan.
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7
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Malbois E, Hurst-Majno S. Empathy is not so perfect! -For a descriptive and wide conception of empathy. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:85-97. [PMID: 36380157 PMCID: PMC9984513 DOI: 10.1007/s11019-022-10124-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Physician empathy is considered essential for good clinical care. Empirical evidence shows that it correlates with better patient satisfaction, compliance, and clinical outcomes. These data have nevertheless been criticized because of a lack of consistency and reliability. In this paper, we claim that these issues partly stem from the widespread idealization of empathy: we mistakenly assume that physician empathy always contributes to good care. This has prevented us from agreeing on a definition of empathy, from understanding the effects of its different components and from exploring its limits. This is problematic because physicians' ignorance of the risks of empathy and of strategies to manage them can impact their work and wellbeing negatively. To address this problem, we explore the effects of the potential components of empathy and argue that it should be conceived as a purely descriptive and wide term. We end by discussing implications for medical education.
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Affiliation(s)
- Elodie Malbois
- Institute for Ethics, History, and the Humanities, University of Geneva, Geneva, Switzerland.
| | - S Hurst-Majno
- Institute for Ethics, History, and the Humanities, University of Geneva, Geneva, Switzerland
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Li W, Lv Y, Duan X, Cheng G, Yao S, Yu S, Tang L, Cheng H. The alterations in event-related potential responses to pain empathy in breast cancer survivors treated with chemotherapy. Front Psychol 2022; 13:942036. [PMID: 36211858 PMCID: PMC9540992 DOI: 10.3389/fpsyg.2022.942036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/04/2022] [Indexed: 01/10/2023] Open
Abstract
Background Previous findings indicated that breast cancer patients often have dysfunction in empathy and other cognitive functions during or after chemotherapy. However, the manifestations and possible neuro-electrophysiological mechanisms of pain empathy impairment in breast cancer patients after chemotherapy were still unknown. Objective The current study aimed to investigate the potential correlations between pain empathy impairment and event-related potentials (ERP) in breast cancer patients undergoing chemotherapy. Methods Twenty-two breast cancer patients were evaluated on a neuropsychological test and pain empathy paradigm before and after chemotherapy, containing the Chinese version of the Interpersonal Reactivity Index (IRI-C), while recording ERP data. Results The empathic concern scores were lower and personal distress scores were higher on IRI-C task compared with those before chemotherapy (t = 3.039, p < 0.01; t = −2.324, p < 0.05, respectively). Meanwhile, the accuracy rates were lower than those before chemotherapy for both pain and laterality tasks on the pain empathy paradigm (F = 5.099, P = 0.035). However, the response time was no significant differences before and after chemotherapy (F = 0.543, P = 0.469). Further, the amplitude of the N1 component was significantly increased (F = 38.091, P < 0.001), and the amplitude of the P2 component was significantly decreased (F = 15.046, P = 0.001) in the subsequent ERP study. A linear mixed effect model was used to analyze the correlation, the average amplitude of N1 and P2 were positively correlated with the accuracy rates in laterality tasks (r = 1.765, r = 1.125, respectively, P < 0.05). Conclusion The results indicated that pain empathy impairment was performed in chemotherapeutic breast cancer patients, which was possibly correlated to the changes of N1 and P2 components in ERP. These findings provide neuro-electrophysiological information about chemo-brain in breast cancer patients.
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Affiliation(s)
- Wen Li
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yue Lv
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xu Duan
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guo Cheng
- Department of Finance, University of Connecticut, Storrs, CT, United States
| | - Senbang Yao
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Sheng Yu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lingxue Tang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Huaidong Cheng
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Huaidong Cheng,
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9
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Historical empathy and medicine: Pathography and empathy in Sophocles’ Philoctetes. MEDICINE, HEALTH CARE AND PHILOSOPHY 2022; 25:561-575. [PMID: 35449242 PMCID: PMC9022738 DOI: 10.1007/s11019-022-10087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/03/2022] [Indexed: 11/24/2022]
Abstract
The aim of this article is to explore the ways in which the engagement with Greek tragedy may contribute fruitfully to the unfolding of empathy in medical students and practitioners. To reappraise the general view that classical texts are remote from modern experience because of the long distance between the era they represent and today, I propose an approach to Greek tragedy viewed through the lens of historical empathy, and of the association between past situations and similar contemporary experiences, in particular. After a brief examination of the concept of empathy, its links with literary reading, and the discussion of these interrelations within the training of narrative medicine, and narrative ethics in particular, the focus turns to selected parts of Sophocles’ Philoctetes, such as the disease scene—an ancient example of pathography. Here Neoptolemus’ empathy for Philoctetes’ situation and its consequences are explored with specific interest in the modern readers’ affective response in connection with their own experiences in medical practice. Neoptolemus’ ethical conflict, which is resolved by his decision to care for Philoctetes, and the problematic nature of this attitude are both indicative of the aim of Greek tragedy to problematize universal issues and thus to point towards the instability of human life and the fluidity of human nature. Realizing through historical empathy the precariousness of human existence may lead to a better understanding and hence better care for others and open new perspectives in the development of empathy within the context of contemporary medical education and practice.
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10
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Abdulkader RS, Venugopal D, Jeyashree K, Al Zayer Z, Senthamarai Kannan K, Jebitha R. The Intricate Relationship Between Client Perceptions of Physician Empathy and Physician Self-Assessment: Lessons for Reforming Clinical Practice. J Patient Exp 2022; 9:23743735221077537. [PMID: 35128044 PMCID: PMC8814954 DOI: 10.1177/23743735221077537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objectives: Clinical empathy is an important predictor of patient outcomes. Several factors affect physician’s empathy and client perceptions. We aimed to assess the association between physician and client perception of clinical empathy, accounting for client, physician, and health system factors. Methods: We conducted a hospital-based cross-sectional study in 3 departments (family medicine, internal medicine, and surgery) of King Saud Medical City in Riyadh, Saudi Arabia. We interviewed 30 physicians and 390 clients from 3 departments. Physicians completed the Jefferson Scale of Empathy (JSE) and the clients responded to the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE). We used a hierarchical multilevel generalized structural equation approach to model factors associated with JSE and JSPPPE and their inter-relationship. Results: Mean (SD) score of client-rated physician empathy was 26.6 (6) and that of physician self-rated was 111 (12.8). We found no association between the 2 (b = 0.06; 95% confidence intervals CI: −0.1, 0.21), even after adjusting for client, physician, and health system factors. Physician's nationality (0.49; 0.12, 0.85), adequate consultation time (1.05; 0.72, 1.38), and trust (1.33; 0.9, 1.75) were positively associated whereas chronic disease (−0.32; −0.56, −0.07) and higher waiting times (−0.26; −0.47, −0.05) were negatively associated. Conclusion: A physician's self-assessed empathy does not correlate with clients’ perception. We recommend training and monitoring to enhance clinical empathy.
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Affiliation(s)
- Rizwan Suliankatchi Abdulkader
- Manonmaniam Sundaranar University, Abishekapatti, Tirunelveli, India.,ICMR-National Institute of Epidemiology, Chennai, India
| | | | | | | | | | - R Jebitha
- Manonmaniam Sundaranar University, Abishekapatti, Tirunelveli, India
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Impaired Cognitive Empathy in Outpatients with Chronic Musculoskeletal Pain: A Cross-Sectional Study. Neural Plast 2021; 2021:4430594. [PMID: 34616448 PMCID: PMC8487839 DOI: 10.1155/2021/4430594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background In recent years, a growing number of researchers showed significant interest in psychological and social interventions to manage chronic musculoskeletal (MSK) pain. Cognitive and emotional empathy is an attractive and valuable sociopsychological factor that may provide protection and resilience against chronic MSK pain. However, its effect on outpatients remains underexplored. Objective To compare the empathy ability between chronic MSK pain outpatients and healthy controls and explore the relationship between cognitive/emotional empathy and chronic pain. Methods Patients with chronic MSK pain (n = 22) and healthy controls (n = 26) completed the pain assessment and empathy ability task, utilizing a multidimensional empathy assessment tool with satisfactory reliability and validity (i.e., the Chinese version of the Multifaceted Empathy Test (MET-C)). Results The data indicated that the chronic MSK pain outpatients had impaired cognitive empathy (i.e., lower squared cognitive empathy accuracy: Student's t = −2.119, P = 0.040, and longer task completion time: Student's t = 3.382, P = 0.002) compared to healthy controls, and cognitive empathy was negatively correlated with pain intensity (r = −0.614, P = 0.002). Further, the impaired cognitive empathy was present in identifying positive, but not negative emotions. Conclusion These results indicate that chronic MSK pain is associated with impaired empathy ability. Our studies contribute to offering a potential direction for developing psychosocial interventions to treat chronic MSK pain.
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Simko LC, Rhodes DC, Gumireddy A, Schreiber J, Booth A, Hawkins M. Effects of a Chronic Pain Simulation Empathy Training Kit on the Empathy of Interprofessional Healthcare Students for Chronic Pain Patients. Clin Simul Nurs 2021. [DOI: 10.1016/j.ecns.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Petersen EA, Schatman ME, Sayed D, Deer T. Persistent Spinal Pain Syndrome: New Terminology for a New Era. J Pain Res 2021; 14:1627-1630. [PMID: 34135626 PMCID: PMC8197591 DOI: 10.2147/jpr.s320923] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael E Schatman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- School of Social Work, North Carolina State University, Raleigh, NC, USA
| | - Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Timothy Deer
- Spine and Nerve Center of the Virginias, Charleston, WV, USA
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Current Understanding of the Involvement of the Insular Cortex in Neuropathic Pain: A Narrative Review. Int J Mol Sci 2021; 22:ijms22052648. [PMID: 33808020 PMCID: PMC7961886 DOI: 10.3390/ijms22052648] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/22/2022] Open
Abstract
Neuropathic pain is difficult to cure and is often accompanied by emotional and psychological changes. Exploring the mechanisms underlying neuropathic pain will help to identify a better treatment for this condition. The insular cortex is an important information integration center. Numerous imaging studies have documented increased activity of the insular cortex in the presence of neuropathic pain; however, the specific role of this region remains controversial. Early studies suggested that the insular lobe is mainly involved in the processing of the emotional motivation dimension of pain. However, increasing evidence suggests that the role of the insular cortex is more complex and may even be related to the neural plasticity, cognitive evaluation, and psychosocial aspects of neuropathic pain. These effects contribute not only to the development of neuropathic pain, but also to its comorbidity with neuropsychiatric diseases. In this review, we summarize the changes that occur in the insular cortex in the presence of neuropathic pain and analgesia, as well as the molecular mechanisms that may underlie these conditions. We also discuss potential sex-based differences in these processes. Further exploration of the involvement of the insular lobe will contribute to the development of new pharmacotherapy and psychotherapy treatments for neuropathic pain.
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Ma J, Wang X, Qiu Q, Zhan H, Wu W. Changes in Empathy in Patients With Chronic Low Back Pain: A Structural-Functional Magnetic Resonance Imaging Study. Front Hum Neurosci 2020; 14:326. [PMID: 32973477 PMCID: PMC7473423 DOI: 10.3389/fnhum.2020.00326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/22/2020] [Indexed: 12/30/2022] Open
Abstract
Objective: Many pieces of research have focused on pain within individuals, but little attention has been paid to whether pain can change an individual’s empathic ability and affect social relationships. The purpose of this study is to explore how chronic low back pain changes empathy. Methods: Twenty-four chronic low back pain patients and 22 healthy controls were recruited. We set up an experimental pain-exposed model for each healthy subject. All subjects received a painful-empathic magnetic resonance scan. After the scan, all subjects rated the pain intensity and multiple empathy-related indicators. The clinical assessment scale was the 20-item Basic Empathy Scale in Adults. Result: The chronic low back pain patients reported lower scores on the total scores of BES-A, the subscale scores of emotional disconnection and cognitive empathy, and the discomfort rating. The fMRI results in the chronic low back pain patients showed that there were multiple abnormal brain pathways centered on the anterior insula. The DTI results in the chronic low back pain patients showed that there were reduced fractional anisotropy values in the corpus callosum, bilateral anterior thalamic radiation (ATR), right posterior thalamic radiation (PTR), right superior longitudinal fasciculus (SLF), and left anterior corona radiate (ACR). Conclusion: Our study found that patients with chronic low back pain have impaired empathy ability. The abnormal functional connectivity of multiple brain networks, multiple damaged white matter tracts, and the lower behavioral scores in chronic low back pain patients supported our findings.
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Affiliation(s)
- Junqin Ma
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xianglong Wang
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qing Qiu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hongrui Zhan
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Department of Physical Medicine and Rehabilitation, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Wen Wu
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Maximiano-Barreto MA, Fabrício DDM, Luchesi BM, Chagas MHN. Factors associated with levels of empathy among students and professionals in the health field: a systematic review. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2020; 42:207-215. [DOI: 10.1590/2237-6089-2019-0035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 11/22/2019] [Indexed: 12/15/2022]
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17
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Karayiannis G, Papastavrou E, Farmakas A, Tsangari H, Noula M, Roupa Z. Exploration of empathy in Cyprus nursing and health care students: A mixed method study. Nurse Educ Pract 2020; 42:102686. [PMID: 31901489 DOI: 10.1016/j.nepr.2019.102686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/20/2019] [Accepted: 12/05/2019] [Indexed: 12/30/2022]
Abstract
Developing professionals who are perceptive to the needs of patients and can respond by expressing empathetic behavior is one of the aims of health care education. The aim of this study was to explore the level of empathy in health care students through a mixed method. The quantitative approach included the use of the Jefferson Scale of Empathy and the qualitative a focus group approach to further deepen into the descriptive results. 869 health care students (RR=81%) participated in the study and the level of empathy ranged from 42 to 139 with a mean score of 100.6 (20-140 scale). Significant statistical differences were found between the disciplines (F=8.6, p-value<0.001) and gender (p-value<0.001) with nursing students and women scoring the higher levels. Two focus groups of ten participants each were conducted with 3rd and 4th year nursing students. Four themes were derived from the analysis of these data a) empathy as an imperative component of care b) contact with the clinical reality c) the influence of family and choice of studies d) gender stereotypes. There is a lack of mixed methodologies in the empathy research and this study provided the opportunity of a better understanding of the health care students' views.
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Halton C, Cartwright T. Walking in a Patient's Shoes: An Evaluation Study of Immersive Learning Using a Digital Training Intervention. Front Psychol 2018; 9:2124. [PMID: 30483174 PMCID: PMC6240611 DOI: 10.3389/fpsyg.2018.02124] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/15/2018] [Indexed: 12/22/2022] Open
Abstract
Objectives: Evidence suggests that immersive learning increases empathy and understanding of the patient experience of illness. This study evaluated a digital training intervention 'In Their Shoes' which immerses participants in the experience of living with inflammatory bowel disease (IBD), highlighting the biopsychosocial impact. The simulation program uses a mobile application to deliver time-based tasks and challenges over 36 h, supplemented with telephone role-play and 'kit' items to open and use. This study investigated changes in IBD understanding and connection to patients, empathy and perception of job value in a group of pharmaceutical employees. Additionally, it explored experiences and impact of taking part in the intervention. Methods: A mixed methods pre-post design was utilized, with an opportunity sample of employees taking part in the training. 104 participants from sites in 12 countries completed measures at baseline and 97 post-intervention. Measures included the Toronto Empathy Questionnaire, Prosocial Job Characteristics Scale, and structured questions around IBD understanding and connection to patients. Two focus groups (N = 14) were conducted regarding participants experiences of the intervention to complement an open-response question in the questionnaire (N = 75). Qualitative data was analyzed using thematic analysis. Results: Following the intervention, there were statistically significant increases in IBD understanding and connection to patients (p < 0.00025), evaluation of organizational innovation (p < 0.00025), empathy (d = 0.45) and prosocial job perceptions (d = 0.28). Qualitative analysis revealed more fully the transformative personal journey undertaken by participants which provided 'eye opening' insight into the psychosocial impact of living and working with IBD. This insight encouraged patient perspective-taking and a strong desire to promote patient advocacy and reduce stigma around chronic illness. Finally, greater organizational pride and connectivity was evident for some participants. Conclusions: An immersive training program, focussing on the lived experience of illness, led to significant increases in disease understanding and empathy. These findings align with other literature evaluating immersive learning and the potential for increasing knowledge, empathy and motivation. The present study offers opportunities to extend this outside of the body of work focussing on healthcare practitioners and explores the benefits of using this type of learning experience within an organizational setting.
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Affiliation(s)
| | - Tina Cartwright
- School of Social Sciences, University of Westminster, London, United Kingdom
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Fauchon C, Faillenot I, Perrin AM, Borg C, Pichot V, Chouchou F, Garcia-Larrea L, Peyron R. Does an observer's empathy influence my pain? Effect of perceived empathetic or unempathetic support on a pain test. Eur J Neurosci 2017; 46:2629-2637. [DOI: 10.1111/ejn.13701] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/12/2017] [Accepted: 08/01/2017] [Indexed: 01/10/2023]
Affiliation(s)
- C. Fauchon
- Central Integration of Pain (NeuroPain); Inserm U1028, UCB Lyon1, UJM; Saint-Etienne France
| | - I. Faillenot
- Central Integration of Pain (NeuroPain); Inserm U1028, UCB Lyon1, UJM; Saint-Etienne France
- Department of Neurology & Pain Center; CHU de Saint-Etienne; Saint-Etienne France
| | - A. M. Perrin
- Department of Neurology & Pain Center; CHU de Saint-Etienne; Saint-Etienne France
- Laboratory EMC (EA3082); University Lyon 2; Lyon-Bron France
| | - C. Borg
- Department of Neurology & Pain Center; CHU de Saint-Etienne; Saint-Etienne France
- Laboratory EMC (EA3082); University Lyon 2; Lyon-Bron France
| | - V. Pichot
- Department of Clinical and Exercise Physiology; EA SNA-EPIS; CHU de Saint-Etienne; Saint-Etienne France
| | - F. Chouchou
- Central Integration of Pain (NeuroPain); Inserm U1028, UCB Lyon1, UJM; Saint-Etienne France
| | - L. Garcia-Larrea
- Central Integration of Pain (NeuroPain); Inserm U1028, UCB Lyon1, UJM; Saint-Etienne France
| | - R. Peyron
- Central Integration of Pain (NeuroPain); Inserm U1028, UCB Lyon1, UJM; Saint-Etienne France
- Department of Neurology & Pain Center; CHU de Saint-Etienne; Saint-Etienne France
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