title: Discounting pain in the absence of medical evidence is explained by negative evaluation of the patient.
abstract: This study investigated the effect on observer responses of the presence/absence of information about medical evidence for pain and psychosocial influences on the patient's pain experience. Additionally, the moderating role of the patient's pain expressions and the mediating role of the observer's belief in deception and evaluation of the patient was examined. Sixty-two participants were presented with videos of 4 patients, each accompanied by a vignette describing the presence or absence of both medical evidence for the pain and psychosocial influences on the patient's pain. Participants estimated patients' pain and rated their own sympathy and inclination to help; they re-estimated patients' pain when the patient's self-report of pain was provided. Finally, participants evaluated each patient as positive or negative and the likelihood that the patient was feigning pain. Participants gave lower ratings on pain, sympathy, and help when medical evidence was absent. Further, in the presence of psychosocial influences, participants took patients' self-reported pain less into account. Next, only for patients expressing high-intensity pain, information about both medical evidence and psychosocial influences was taken into account. Finally, the observer's evaluation of the patient and his/her belief in deception fully, respectively partially, explained the effect of medical evidence. The results indicate that discounting pain in the absence of medical evidence may involve negative evaluation of the patient. Further, the patient's pain expression is a moderating variable, and psychosocial influences negatively impact the degree to which patients' self-reports are taken into account. The results indicate that contextual information impacts observer responses to pain.
authors: Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium Department of Experimental Psychology, Ghent University, Ghent, Belgium Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
authors: Lies
authors: L
authors: De Ruddere
authors: Liesbet
authors: L
authors: Goubert
authors: Michaël
authors: M
authors: Stevens
authors: Amanda C
authors: AC
authors: de C Williams
authors: Geert
authors: G
authors: Crombez
mesh_terms: D000328:Adult; D000368:Aged; D001519:Behavior; D008192:Deception; D004645:Empathy; D005149:Facial Expression; D030141:Feedback, Psychological; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000523:psychology; D010147:Pain Measurement; D010361:Patients; D014741:Video Recording; D055815:Young Adult
references: Allegretti A, Borkan J, Reis S, Griffiths F. Paired interviews of shared experiences around chronic low back pain: classic mismatch between patients and their doctors. Fam Pract. 2010;27:676-683.
references: Beesdo K, Jacobi F, Hoyer J, Low NCP, Höfler M, Wittchen H-U. Pain associated with specific anxiety and depression disorders in a nationally representative population sample. Soc Psychiatry Psychiatr Epidemiol. 2010;45:89-104.
references: Breivik H. Opioids in chronic non-cancer pain, indications and controversies. Eur J Pain. 2005;9:127-160.
references: Carragee EJ. Persistent low back pain. N Engl J Med. 2005;352:1891-1898.
references: Chibnall JT, Tait RC. Observer perceptions of low back pain: effects of pain report and other contextual factors. J Appl Soc Psychol. 1995;25:418-439.
references: Chibnall JT, Tait RC. Social and medical influences on attributions and evaluations of chronic pain. Psychol Health. 1999;14:719-729.
references: Craig KD, Badali MA. Introduction to the special series on pain deception and malingering. Clin J Pain. 2004;20:377-382.
references: De Ruddere L, Goubert L, Prkachin KM, Stevens MAL, Van Ryckeghem DML, Crombez G. When you dislike patients, pain is taken less seriously. PAIN®. 2011;152:2342-2347.
references: De Ruddere L, Goubert L, Vervoort T, Kappesser J, Crombez G. The impact of being primed with social deception on observer responses to others’ pain. PAIN®. 2012;154:221-226.
references: De Ruddere L, Goubert L, Vervoort T, Prkachin KM, Crombez G. We discount the pain of others when pain has no medical explanation. J Pain. 2012;13:1198-1205.
references: Eccleston C, Crombez G. Worry and chronic pain: a misdirected problem solving model. PAIN®. 2007;132:233-236.
references: Eccleston C, de C.Williams AC, Rogers WS. Patients’ and professionals’ understandings of the causes of chronic pain: blame, responsibility and identity protection. Soc Sci Med. 1997;45:699-709.
references: Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133:581-624.
references: Goubert L, Crombez G, De Bourdeaudhuij I. Low back pain, disability and back pain myths in a community sample: prevalence and interrelationships. Eur J Pain. 2004;8:385-394.
references: Hadjistavropoulos T, Craig KD, Duck S, Cano A, Goubert L, Jackson PL, Mogil JS, Rainville P, Sullivan M, Williams AC, Vervoort T, Fitzgerald TD. A biopsychosocial formulation of pain communication. Psychol Bull. 2011;137:910-939.
references: Hiller W, Rief W, Brähler E. Somatization in the population: from mild bodily misperceptions to disabling symptoms. Soc Psychiatry Psychiatr Epidemiol. 2006;41:704-712.
references: Holloway I, Sofaer-Bennett B, Walker J. The stigmatization of people with chronic back pain. Disabil Rehabil. 2007;29:1456-1464.
references: Jacobi F, Wittchen HU, Hölting C, Höfler M, Pfister H, Müller N, Lieb R. Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med. 2004;34:597-611.
references: Judd CM, Kenny DA, McClelland GH. Estimation and testing mediation and moderation in within-subject designs. Psychol Methods. 2001;6:115-134.
references: Kappesser J, de C.Williams AC, Prkachin KM. Testing two accounts of pain underestimation. PAIN®. 2006;124:109-116.
references: Lahmann C, Henningsen P, Noll-Hussong M. Somatoform pain disorder to overview. Psychiatr Danub. 2010;22:453-458.
references: Lieb R, Pfister H, Mastaler M, Wittchen HU. Somatoform syndromes and disorders in a representative population sample of adolescents and young adults: prevalence, comorbidity and impairments. Acta Psychiatr Scand. 2000;101:194-208.
references: Linton SJ. A review of psychological risk factors in back and neck pain. Spine. 2000;25:1148-1156.
references: Matthias MS, Parpart AL, Nyland KA, Huffman MA, Stubbs DL, Sargent C, Bair MJ. The patient–provider relationship in chronic pain care: providers’ perspective. Pain Med. 2010;11:1679-1688.
references: Peters S, Stanley I, Rose M, Salmon P. Patients with medically unexplained symptoms: sources of patients’ authority and implications for demands on medical care. Soc Sci Med. 1998;46:559-565.
references: Pincus T, Burton AK, Vogel S, Fiels AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine. 2002;27:E109-E120.
references: Prkachin KM. The consistency of facial expressions of pain: a comparison across modalities. PAIN®. 1992;51:297-306.
references: Rief W, Hessel A, Braehler E. Somatization symptoms and hypochondriacal features in the general population. Psychosom Med. 2001;63:595-602.
references: Rocha E, Prkachin KM, Beaumont SL, Hardy C, Zumbo BD. Pain reactivity and illness behavior in kindergarten-aged children. J Pediatr Psychol. 2003;28:47-57.
references: Sinatra R. Causes and consequences of inadequate management of acute pain. Pain Med. 2010;11:1859-1871.
references: Spacek A. Modern concepts of acute and chronic pain management. Biomed Pharmacother. 2006;60:329-335.
references: Tait RC, Chibnall JT. Observer perceptions of chronic low back pain. J Appl Soc Psychol. 1994;24:415-431.
references: Tait RC, Chibnall JT. Physician judgments of chronic pain patients. Soc Sci Med. 1997;45:1199-1205.
references: Tait RC, Chibnall JT, Kalauokalani D. Provider judgments of patients in pain: seeking symptom certainty. Pain Med. 2009;10:11-34.
references: Taylor AG, Skelton JA, Butcher J. Duration of pain condition and physical pathology as determinants of nurses’ assessments of patients in pain. Nurs Res. 1984;33:4-8.
references: Toye F, Barker K. ‘Could I be imagining this?’ to the dialectic struggles of people with persistent unexplained back pain. Disabil Rehabil. 2010;32:1722-1732.
references: Verbruggen F, Aron AR, Stevens MA, Chambers CD. Theta burst stimulation dissociates attention and action updating in human inferior frontal cortex. Proc Natl Acad Sci USA. 2010;107:13966-13971.
references: Wasan AD, Wootton J, Jamison RN. Dealing with difficult patients in your pain practice. Reg Anesth Pain Med. 2005;30:184-192.
references: Werner A, Malterud K. It is hard work behaving as a credible patient: encounters between women with chronic pain and their doctors. Soc Sci Med. 2003;57:1409-1419.
references: de C.Williams AC. Facial expression of pain: an evolutionary account. Behav Brain Sci. 2002;25:439-488.