The effect of patient-practitioner communication on pain: a systematic review.
OBJECTIVE
Communication between patients and health care practitioners is expected to benefit health outcomes. The objective of this review was to assess the effects of experimentally varied communication on clinical patients' pain.


METHODS
We searched in July 2012, 11 databases supplemented with forward and backward searches for (quasi-) randomized controlled trials in which face-to-face communication was manipulated. We updated in June 2015 using the four most relevant databases (CINAHL, Cochrane Central, Psychinfo, PubMed).


RESULTS
Fifty-one studies covering 5079 patients were included. The interventions were separated into three categories: cognitive care, emotional care, procedural preparation. In all but five studies the outcome concerned acute pain. We found that, in general, communication has a small effect on (acute) pain. The 19 cognitive care studies showed that a positive suggestion may reduce pain, whereas a negative suggestion may increase pain, but effects are small. The 14 emotional care studies showed no evidence of a direct effect on pain, although four studies showed a tendency for emotional care lowering patients' pain. Some of the 23 procedural preparation interventions showed a weak to moderate effect on lowering pain.


CONCLUSIONS
Different types of communication have a significant but small effect on (acute) pain. Positive suggestions and informational preparation seem to lower patients' pain. Communication interventions show a large variety in quality, complexity and methodological rigour; they often used multiple components and it remains unclear what the effective elements of communication are. Future research is warranted to identify the effective components.
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
P
P
Mistiaen
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
M
M
van Osch
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
L
L
van Vliet
Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
J
J
Howick
Faculty of Social and Human Sciences, University of Southampton, UK.
F L
FL
Bishop
School of Applied Psychology, University College Cork, Ireland.
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Z
Di Blasi
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.|Department of Clinical and Health Psychology, Utrecht University, The Netherlands.
J
J
Bensing
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.|Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, The Netherlands.|Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway.
S
S
van Dulmen
D059787:Acute Pain / Q000523:psychology / Q000628:therapy*; D003142:Communication; D006801:Humans; D059408:Pain Management / Q000379:methods* / Q000523:psychology; D010817:Physician-Patient Relations; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome