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Pain Management
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Communication with doctor during first visit affects pain patients’ outcomes
Chronic pain — defined as daily or significant pain that lasts more than three months — can be complicated to diagnose and treat. Because chronic pain conditions are clouded with uncertainties, patients often struggle with anxiety and depression, and they and their doctors frequently find these conditions challenging to discuss and manage, studies have indicated.
A recent study of 200 adults with chronic neck or back pain, led by University of Illinois Urbana-Champaign communication professor Charee Thompson, found that effective physician-patient communication during the initial consultation helps patients manage their uncertainties, including their fears, anxieties and confidence in their ability to cope with their condition.
“We found that providers and patients who perceive themselves and each other as competent medical communicators during consultations can alleviate patients’ negative feelings of uncertainty, such as distress, and increase their positive feelings about uncertainties, such as their sense of hope and beliefs in their pain-management self-efficacy,” Thompson said. “Providers and patients successfully manage patients’ uncertainty through two fundamental medical communication processes — informational and socioemotional, each of which can have important clinical implications.”
According to the study, informational competence reflects patients’ abilities to accurately describe their symptoms and verify their understanding of doctors’ explanations and instructions, as well as clinicians asking appropriate questions, providing clear explanations and confirming patients’ understanding. The extent to which doctors and patients establish a trusting relationship through open, honest communication and patients’ feelings of being emotionally supported by the physician reflects socioemotional communication competence.
Thompson and her co-authors—Manuel D. Pulido, a communication professor at California State University, Long Beach; neurosurgery chair Dr. Paul M. Arnold and medical student Suma Ganjidi, both of the Carle Illinois College of Medicine—published their findings in the Journal of Health Communication.
More than 51 million adults in the U.S. — about 21% of the population — experienced chronic pain in 2021, resulting in substantial healthcare costs and lost productivity, according to a report on the U.S. Centers for Disease Control and Prevention’s website.
The current study was based on uncertainty management theory, the hypothesis that people faced with uncertainty about a health condition appraise it and decide whether obtaining information is a benefit or a threat. For example, patients may seek information about the origins of a new symptom to mitigate their anxiety-related uncertainty — or, conversely, they might avoid information-seeking so they can maintain hopeful uncertainty about their prognosis, the team wrote.
The study was conducted at an institute in the Midwest composed of several clinics and programs that treat diseases and injuries of the brain, spinal cord, and nervous system. The study sample, ranging in age from 18 to 75, had pain in their neck, back, buttocks, and lower extremities. About 59% of the patients were female.
Before the consultation, the patients completed surveys rating how they experienced and managed their pain and their certainty or uncertainty about it. They and the providers also completed post-consultation surveys rating themselves and each other on their communication skills.
The patients rated how well the provider ensured that they understood their explanations and asked questions related to their medical problem.
To determine if patients’ levels of uncertainty changed, on the pre- and post-consultation surveys the patients ranked how certain or uncertain they felt about six aspects of their pain — including its cause, diagnosis, prognosis, the available treatment options and the risks and benefits of those. The patients also rated themselves on catastrophizing — their tendency to worry that they would always be in pain and never find relief.
Patients’ feelings of distress were reduced when they and their physician mutually agreed that the other person was effective at seeking and providing medical information, and when the patients felt emotionally supported by their doctors, the team found.
“Patients’ ratings of their providers’ communication competency significantly predicted reductions in their pain-related uncertainty and in their appraisals of fear and anxiety, as well as increases in their positive uncertainty and pain self-efficacy,” Thompson said. “Providers’ reports of patients’ communication competency were likewise associated with decreases in patients’ pain-related uncertainty and marginally significant improvements in their positive appraisals of uncertainty.”
Researchers explore new methods for quantifying chronic pain in women
Over 70% of chronic pain cases are women. Effective treatment of pain has been hampered by an entirely subjective protocol for measuring pain severity, with variation introduced in patient assessments and physician biases. Credit Arocamora, CC BY-SA 4.0
Chronic pain affects millions of people, with women experiencing more severe and frequent pain than men. Over 70% of chronic pain cases involve women. However, measuring and managing pain remains a complex challenge. There is currently no objective method to quantify pain, which makes it difficult to tailor treatments effectively. Additionally, there are significant variations in how patients experience pain and how physicians respond. A new research initiative aims to address these issues.
Tufts University, in collaboration with external partners, has been selected by the Advanced Research Projects Agency for Health (ARPA-H) as an award recipient for the Sprint for Women’s Health. This initiative aims to develop new technologies for quantitatively measuring pain in patients, to improve care and accelerate the development of new treatments. The team will receive $3.03 million in funding over the next two years.
Various factors, such as inflammation, damaged nerves, or conditions like fibromyalgia, can cause chronic pain. Each of these causes may require a different treatment approach. Regardless of its origin, pain is highly subjective and can be influenced by psychological, social, and other factors. While elite athletes and soldiers often train to tolerate high levels of pain, individual reactions to pain can vary significantly among those who experience it.
Standard practice in assessing pain in the clinical setting is entirely subjective—something most of us have experienced if asked to measure it on a chart using smiling to frowning emoticons.
Subjectivity in assessing pain is not just on the patient’s side. Bias also occurs on the treatment side, with some minority groups being undertreated for managing pain compared to the general population.
“Having an objective, quantitative tool to assess pain will help eliminate subjective variables and provide a more rational basis for treatment,” said Sameer Sonkusale, a professor of electrical and computer engineering at the Tufts School of Engineering and the principal investigator on the project. The project includes collaborators from the Uniformed Services University of Health Sciences (USU), The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), and Northwestern Medicine.
The research team plans to screen more than 30 biomarkers, including stress hormones, inflammation markers, and neurotransmitters in the interstitial fluid that circulates between skin cells. Additionally, they will monitor physiological responses such as fluctuations in heart rate, galvanic skin response, and breathing patterns.
These biomarkers were identified in earlier studies as linked to a patient’s experience of pain, but this is the first effort to create a composite panel of markers to generate a quantitative score for pain.
The biomarker data will be merged with answers to pain questionnaires collected from women at several sites, including the Defense and Veterans Center for Integrative Pain Management and Northwestern Medicine. Shuchin Aeron, an electrical and computer engineering associate professor at Tufts, will apply artificial intelligence and machine learning to combine these factors into an objective and quantitative pain score.
The researchers will narrow the panel to five or more of the most reliable pain-linked biomarkers. These biomarkers can be monitored on a portable, wearable device for clinical site and remote pain assessment. The results would instantly be reported to the physician or the patient on a smartwatch or ring.
The availability of such devices would not only improve pain management. Still, it could also accelerate the development of new drugs and treatments, which could benefit from an objective measure of their effectiveness.
“While pain reporting is subjective and dependent on many extraneous factors, for the same pain level, the measurable physiological markers and signals are expected to be similar from one individual to the next,” said Sonkusale. “Considering an observed gender bias in the prevalence and approach to treatment of chronic pain, this technology addresses a large unmet medical need for women, creating a path to more effective pain management.”
“It has been extremely challenging to objectively quantify nociplastic pain—the type of pain involving nervous system sensitization in conditions like fibromyalgia that are quite common in women. This study could provide a way to objectively quantify pain in a way that will greatly help their treatment,” said Steven P Cohen, Edmond I Eger Professor of Anesthesiology and Pain Medicine at Northwestern Medicine.
Reducing daily sitting may prevent back pain
The study from the Turku PET Centre and UKK Institute in Finland looked into whether reducing daily sitting could help prevent or relieve back pain in overweight or obese adults who spend most of their day sitting. The participants were able to reduce their sitting time by an average of 40 minutes per day over the six-month study period.“Our participants were quite normal middle-aged adults, who sat a great deal, exercised little, and had gained some extra weight. These factors increase the risk for cardiovascular disease and back pain,” says Doctoral Researcher and Physiotherapist Jooa Norha from the University of Turku in Finland.
Previous results from the same and other research groups have suggested that sitting may be detrimental to back health, but the data has been preliminary.
Robust methods for studying the mechanisms behind back pain
The researchers also examined potential mechanisms behind the prevention of back pain.
”However, we did not observe that the changes in back pain were related to changes in the fattiness or glucose metabolism of the back muscles,” Norha says.
Individuals with back pain have excessive fat deposits within the back muscles, and impaired glucose metabolism or insulin sensitivity can predispose to pain. Nevertheless, back pain can be prevented or relieved even if no improvements in muscle composition or metabolism occur. The researchers measured the back muscles using magnetic resonance imaging (MRI) and PET imaging based on a radioactive tracer.
“If you have a tendency for back pain or excessive sitting and are concerned for your back health, you can try to figure out ways to reduce sitting at work or during leisure time. However, it is important to note that physical activity, such as walking or more brisk exercise, is better than simply standing up,” Norha points out.
The researchers wish to remind us that switching between postures is more important than seeking the perfect posture.