Physician Empathy and Chronic Pain Outcomes

Physician Empathy and Chronic Pain Outcomes

JAMA Network Open

April 1, 2024; Vol. 7; No. 4; e246026

John C Licciardone, DO, MD, MBA; Yen Tran, BS; Kang Ngo, BSA; et al: from the University of North Texas Health Science Center and Johns Hopkins University. This study cites 33 references.

This study is unique in that it measured empathy as perceived by patients rather than self-reported by physicians. This study used 1,470 adults with a mean age of 53 years, and 74% were female. All patients suffered from chronic low back pain. Follow-up assessment was at 12 months.

The main outcomes were patient-reported pain, function, and health-related quality-of-life (HRQOL), as measured with a numerical rating scale for low back pain intensity, the Roland-Morris Disability Questionnaire for back-related disability, and the Patient-Reported Outcomes Measurement Information System for HRQOL deficits pertaining to anxiety, depression, fatigue, sleep disturbance, and pain interference.

Sociodemographic variables included age, sex, race, ethnicity, and educational level.

Health history included smoking status, musculoskeletal comorbidities (herniated disc, sciatica, osteoarthritis, and osteoporosis), and general medical comorbidities (hypertension, heart disease, diabetes, asthma, and depression).

Chronic low back pain treatment included nonpharmacological treatments (exercise, yoga, massage therapy, spinal manipulation, acupuncture, and cognitive behavioral therapy), opioid therapy, and lumbar spine surgery.

The Consultation and Relational Empathy (CARE) measure is the primary patient rating instrument for physician empathy. Patients reported their physician’s empathy at enrollment using the CARE measure. CARE includes 10 items about characteristics pertaining to physician empathy during medical encounters using this rating scale: ATTACH AT THE END OF REVIEW

1. for poor
2. for fair
3. for good
4. for very good
5. for excellent

Higher scores indicate greater physician empathy.

“Physicians whose scores were 30 or higher (ie, rated as good, very good, or excellent on most items) were classified as very empathic physicians (VEPs).”

“Physicians whose scores were 29 or lower (ie, rated as poor or fair on most items) were classified as slightly empathic physicians (SEPs).”

KEY POINTS FROM THIS ARTICLE:

1) “The patient-physician relationship is vital among patients with chronic low back pain (CLBP) because patients often feel isolated, misunderstood, or stigmatized when an underlying cause of pain cannot be identified.”

2) “Medical students and residents often become less empathic during education and training, owing to a greater perceived need for patient detachment and reliance on technology.”

3) Findings:

• “Current opioid use was associated with greater pain intensity and back-related disability.” [Important]
• “Lumbar spine surgery was associated with greater back-related disability.”
• “In this cohort study of adult patients with chronic pain, physician empathy was associated with better outcomes over 12 months.”
• “Greater physician empathy was inversely associated with pain intensity, back-related disability, and HRQOL deficits on each measure.” [Key Point]
• “All physician empathy group differences were clinically relevant.”
• “Physician empathy was associated with more favorable outcomes than non-pharmacological treatments, opioid therapy, and lumbar spine surgery.”
• “Physician empathy may enhance patient adherence to treatment and improve clinical outcomes.”
• “Physician empathy was strongly associated with satisfaction among patients with CLBP even after controlling for confounders.”
• “The CARE measure score was inversely associated with pain intensity, back-related disability, and each HRQOL deficit.”
• Greater levels of physician empathy were associated with better outcomes in pain, function, and HRQOL.

4) Conclusions:

• “In this cohort study of adults with CLBP, physician empathy was inversely associated with pain intensity, back-related disability, and HRQOL deficits in all main analyses, including those that controlled for time effects and a wide array of sociodemographic and clinical covariates at baseline and also for current opioid use and lumbar spine surgery over 12 months.”
• “In this cohort study that included 1470 adults with chronic low back pain, patients treated by very empathic physicians reported having significantly better and clinically relevant outcomes pertaining to pain, function, and health-related quality of life over 12 months compared with patients treated by slightly empathic physicians.” [Key Point]
• “Physician empathy is an important aspect of the patient-physician relationship and was associated with better outcomes among patients with chronic pain.”
• “Physician empathy was more strongly associated with favorable outcomes than were nonpharmacological treatments, opioid therapy, and lumbar spine surgery.”
• “Physician empathy is an important aspect of the patient-physician relationship among those with chronic pain.”
• “Empathy is an essential aspect of the patient-physician relationship in delivering patient-centered care.”
  • This is particularly important in pain medicine.