A new study of worldwide polling data suggests that a person’s income rank relative to their peers is linked to their experience of physical pain. A lower income rank is linked to a higher likelihood of experiencing pain. It is the first time such a relationship has been shown.

The study found the link to persist to the same degree, irrespective of whether the person lives in a rich or poor country.

Income rank is the position of an individual’s absolute income amount in a list ordered from lowest to highest.  The higher the position in the list, the higher the income rank.

The study, authored by Dr Lucía Macchia, Lecturer in Psychology at City, University of London, also suggests that people in poor countries fare no better than those living in rich countries when it comes to the effect of the absolute amount of personal income they earn on the likelihood of them experiencing pain. This was an unexpected finding and requires further investigation. The prediction was that those in poorer countries would be more strongly affected, assuming that an increase in absolute income would allow them to obtain more resources to support their well-being that is more readily available in rich countries.

Overall, the study findings suggest that an overriding factor affecting a person’s pain levels based on their personal income could be negative emotions related to their appraisal of their income ranking compared to their peers. It relates to their perception of their own levels of deprivation relative to their peers (in keeping with Relative Deprivation Theory) or their standing in a society and a feeling of a lack of social mobility (Social Comparison theory).

In the study, analyses were made of data from the annual World Gallup Poll (GWP), across the years 2009-18, and consisting of responses from approximately 1.3 million adult survey respondents from across 146 countries.  Respondents were asked what their total monthly household income was before taxes, which was divided by the number of people in their household to derive the respondent’s personal income amount.  Respondents were also asked whether they experienced physical pain the day before being surveyed, to which they could respond ‘yes’ or ‘no’. In the analyses, linear regression models were created from these data and further ancillary information.

This study refers to pain as the feeling that people experience when their body hurts regardless of the presence of physical damage.

Physical pain is one of the main reasons people visit the accident and emergency room in the UK. Approximately nine million people live with chronic pain in the UK and musculoskeletal pain alone accounts for 30 per cent of the country’s medical consultations.

Physical pain has been increasing dramatically in the last decades, becoming a priority for global public health. Pain affects leisure and productivity at work, increases health care costs, and represents a major challenge for healthcare systems. Pain plays a key role in suicide and in drug and alcohol misuse. In light of these circumstances, understanding the context of pain is crucial to addressing its consequences.

Study author, Dr Lucía Macchia, said:

“This is the first study that shows that income rank and pain are linked around the world. It suggests that psychological factors related to the well-known phenomenon of social comparison may influence people’s physical pain.”

An online “e-health” program helped more people with chronic pain reduce their opioid medications and pain intensity than a control group that had only regular treatment in a recent clinical study.

In the study published in the journal Pain, about 400 participants who had been prescribed long-term opioid treatment for their pain were divided into two groups: one received treatment as usual and another received treatment and access to a self-guided, e-health program. Of the e-health group, more than half, 53.6%, were able to reduce their opioid medications by 15% or more after six months compared to 42.3% of patients in the control group.

“These were very encouraging findings: not only were they reducing opioids but also their pain was not becoming worse,” said Washington State University nursing associate professor Marian Wilson and the study’s lead author. “Some people are hesitant to stop their opioid medication because they fear their pain will increase, but we found that at least on average in this population, they could reduce their opioids a bit and not have increased pain symptoms.”

An estimated 50 million people in the U.S. have chronic pain and about 18 million are prescribed long-term opioid treatment. Since opioid use risks include addiction and even accidental death, researchers are searching for alternatives to help these patients.

At the start of this study, all the participants rated their chronic pain at an average intensity of 5 or 6 on a 0 to10 point scale with 10 being the most extreme pain. Chronic pain can arise from a range of conditions that have no cure, and the study participants had a range of diagnoses including arthritis, back pain, fibromyalgia and migraines.

At the end of the study, 14.5% of the e-health group reported that their pain was reduced by 2 points or more. Only 6.8% in the control group had the same level of pain decrease. The researchers also observed the patients improved their pain knowledge, confidence managing pain and coping skills.

For this study, the researchers used a psychologist-designed e-health program, called Goalistics Chronic Pain Management. This self-guided course aims to help people manage their own pain and its many impacts on their lives. The program contains a mix of pain tracking tools, cognitive therapy, exercise tips and relationship advice as well as information about opioid use and risks.

The program provides content similar to what a patient might receive from a psychologist who specializes in pain, a treatment that isn’t easily accessible for everyone, said Wilson.

While similar programs exist, the researchers chose this one because it is widely available in the U.S. and delivered fully online. Wilson also tested the Goalistics program in previous research providing preliminary data for this study’s large, randomized trial.

Since pain is such an individualized experience, the authors argue that patients can benefit from self-management programs so they can track their pain levels and experiment with different strategies.

 “The idea is to put the patient in the driver’s seat because we can give them a prescription for opioids, and that will work for a little while, but over time for chronic pain, it’s not usually going to be the solution to fix all their troubles,” she said.

Wilson added that chronic pain patients often have mood, social and physical functioning issues that also need attention.

The findings provide more evidence that online self-management programs are beneficial for chronic pain patients, and a variety of agencies, including the Centers for Disease Control and Prevention, support their widespread use.

At the time of this study, the e-health program had a monthly $30 fee. While relatively inexpensive compared to treatment by a pain psychologist, these types of programs are not covered by most insurance in the U.S. Other countries including Canada and Australia provide similar programs to patients for free, and Wilson is currently working on a project that aims to achieve greater access in the U.S.

Researchers measured the associations among process, outcomes and patient satisfaction within general medical care for chronic low back pain provided through an ongoing patient-physician relationship. They also used two models to measure factors associated with patient satisfaction, including studying a subgroup of participants experiencing chronic low back pain treated by the same physician for more than five years.

Among 1,352 participants, only physician empathy and communication were associated with patient satisfaction in the multivariable analysis that controlled for potential confounders. Similarly, in the subgroup of 355 participants, physician empathy and communication remained linked to patient satisfaction in the multivariable analysis.

Physician empathy and physician communication were strongly associated with patient satisfaction with medical care for chronic low back pain. Researchers argue that patients with chronic pain highly value physicians who are empathic and who make efforts to more clearly communicate treatment plans and expectations.

What is Known on This Topic: Despite medical advances in managing chronic pain experienced by millions of Americans, little research has been conducted on how patient-physician interaction impacts the process of delivering medical care for chronic low back pain and, ultimately, patient satisfaction.

What This Study Adds: Patients with chronic pain highly value empathic physicians who validate their concerns and often ill-defined symptoms, as well as physicians who make efforts to more clearly communicate treatment plans and expectations to patients.