Patients' self-criticism is a stronger predictor of physician's evaluation of prognosis than pain diagnosis or severity in chronic pain patients.
The experience of pain is influenced by patients' personality, social and cultural background, and patient-doctor interaction. This study examines the role of self-reported pain, pain diagnosis, age, gender, depression, and the personality trait of self-criticism (defined as individuals' tendency to set unrealistically high self-standards and to adopt a punitive stance toward one's self), in determining physicians' view of expected prognosis in response to chronic pain management. Before the first visit to a tertiary chronic pain clinic, patients provided information regarding their perceived pain, depression, and self-criticism. Immediately subsequent to the visit, physicians' evaluated expected prognosis. Participating physicians were blinded to the patient's psychosocial variables collected. Sixty-four patients with chronic pain (34 women and 30 men) with various diagnoses were included. Patients' age, gender, pain diagnosis, self-reported pain, and depression did not significantly correlate with physician's estimation of expected prognosis. In contrast, patients' self-criticism emerged as an independent predictor of physicians' pessimism regarding outcome. Thus, in the chronic pain clinic setting, patients' personality, rather than self-reported pain experience, determines doctor's clinical judgment of expected prognosis.


CONCLUSIONS
Chronic pain is a multimodal negative experience that is determined by physiological, cognitive, personological, and interpersonal factors. In line with this observation, we found patients' personality, specifically, their self-criticism, determines physicians' clinical judgment of expected prognosis.
Rudich
Zvia
Z
The Pain Clinic, Division of Anesthesia and Intensive Care, Soroka University Medical Center, Beer-Sheva, Israel. rudich@bgu.ac.il
Lerman
Sheera F
SF
Gurevich
Boris
B
Weksler
Natan
N
Shahar
Golan
G
D002908:Chronic Disease; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000150:complications / Q000175:diagnosis* / Q000523:psychology*; D010147:Pain Measurement; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012649:Self Concept; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires