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.”