Empathetic Response to Chronic Pain

A Spouse’s Response to a Patient’s Pain – By Cheryl Zigrand – October 05, 2017

Though this article is almost a year old, it points out that empathy is still a healing force, despite its recent demonization for supposedly promoting a patient’s “catastrophizing“.

While it may be common sense that everyday interpersonal experiences play a role in the link between close relationships and physical health, few studies have been able to make any firm conclusions. Recently, however, researchers set out to close the gap in what is known about how spouses’ responses may or may not affect long-term physical functioning.

The research team, based at Penn State University, examined the association between the expression of pain made by patients with knee osteoarthritis and how their spouses responded to it, and changes in the patients’ physical function over 18 months.  

…questions measured spouses’

  1. solicitous,
  2. punishing, and
  3. empathic

behaviors.

Then, the data were analyzed to determine whether the extent to which spouses’ daily responses aligned with patients’ everyday verbal pain expression predicted changes in patients’ physical function prospectively.

Does kindness really help patients feel better?

Most of the 145 couples who participated in the Penn State study were older (mean age: 65.6 years old for patients, 65.3 for spouses) and white (88% of patients, 86% of spouses).

As the researchers predicted, patients whose spouses responded to their expressions of pain with more empathy demonstrated better physical function over time compared with those whose spouses responded with less empathy.

This contradicts the belief that sympathy from loved ones only encourages “pain behavior”, which makes pain worse because it increases catasrophizing.

Therefore, daily responsiveness was found to be an important factor in patients’ long-term, objectively assessed physical function. “However, neither solicitous nor punishing responsiveness predicted change in physical function,” the authors wrote

Other research has noted similar overall trends with regard to empathy and pain.

“We’ve found that empathy expressed by a romantic partner to the person experiencing pain is related to greater psychological and relationship well-being, as well as less pain.

It’s unusual, though, for studies to link everyday interactions with longer-term changes in health. “This study adds to the literature by showing that daily empathic responsiveness has an association with improved physical function over a relatively long time period,” adds Dr. Cano.

Acknowledge the pain, don’t ignore it

Robert D. Kerns, PhD, a professor of psychiatry, neurology, and psychology at Yale University in New Haven, Conn., says, “It seems most important to assess patients’ experience or interpretation of responses from others rather than the reports of others about their apparent intent.”

For example, even when a spouse intends to communicate empathy, it’s possible that the patient will perceive the response as negative or critical.

Clinicians may need to keep an open mind in order to view these study findings in light of the popular operant model of pain, in which pain expressions should be ignored to avoid reinforcing behaviors that may lead to further pain or disability.

This statement about “the popular operant model of pain” led me to do some research on that “operant model”, which I think of mainly as useful for training animals or young children who cannot understand language and explanations yet.

“Operant conditioning”
punishes undesired behavior (“pain behavior”) and
rewards desired behavior (“sucking it up”).

This “operant” model dehumanizes pain patients and their pain, visualizing them as mere “actors” exhibiting various undesired “behaviors” when they are in pain. That would certainly explain the dismissive attitude which which pain is regarded.

These days, I no longer know how to act around my own medical care team.

If I show any signs of pain, like that little gasp when getting up and having the sore muscles grab, it can be viewed as deliberate “pain behavior” and I could be suspected of exaggerating it because I’m “drug seeking”. But if I don’t show my pain and just talk about it, I worry they won’t believe me.

“Clinicians will need to reconcile these and similar findings with their pain management training, which has historically focused on eliminating behaviors such as verbal pain expressions by ignoring them,” explains Dr. Cano.

Ultimately, it comes down to a holistic approach, Dr. Kerns says: “Astute clinicians will specifically assess the family and broader cultural context and use a comprehensive assessment, including this [study’s] focus, to inform a mutually agreed upon, patient-centered, evidence-based, integrated, multimodal, and interdisciplinary plan of care.”

The words are oh-so-correct, but if all that “stuff” doesn’t work for a patient, does “multi-modal care” still include opioid medication?

3 thoughts on “Empathetic Response to Chronic Pain

  1. canarensis

    “These days, I no longer know how to act around my own medical care team.

    If I show any signs of pain, like that little gasp when getting up and having the sore muscles grab, it can be viewed as deliberate “pain behavior” and I could be suspected of exaggerating it because I’m “drug seeking”. But if I don’t show my pain and just talk about it, I worry they won’t believe me.”

    omg, that rings so close to home. I’ve always been a teeth gritter rather than a hollerer, & most doctors don’t even notice the involuntary winces or gasps that do escape. And I’m terrified no matter how I react/don’t react; will they think I’m dramatizing for effect? If I don’t scream & thrash around, will they assume there’s no pain? We can’t frigging win.

    operant model of pain: further proof that really bad ideas never die.

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      No, we cannot win :-( Without a doctor who believes what you explain to them about your pain, it’s impossible to get good care. Just like with any other medical condition, the doctor must believe what you tell them for a diagnosis and treatment.

      But these days, pain is a special symptom that generates more suspicion than concern and doctors are encouraged to ignore it. And if they can’t do that, then they are advised to prescribe all kinds of “alternative” therapies that have not been scientifically proven effective because they are forbidden to treat us with effective opioids.

      How did a legitimate medical condition get so wrapped up in and confused with the addiction crisis? How will we ever get it untangled again?

      We can only hope that the addiction crisis will move on to other drugs, which it is already starting to do, and move the focus off our opioids.

      Liked by 1 person

      Reply

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