Provider judgments of patients in pain: seeking symptom certainty

Abstract

Objective: Uncertainty often surrounds judgments of pain, especially when pain is chronic. In order to simplify their decisions, providers adduce information from a variety of sources. Unfortunately, an extensive literature suggests that the information that is brought to bear actually can bias pain judgments, resulting in judgments that consistently differ from patient reports, with a potential negative impact on treatment.

Methods: This review examines the pain assessment literature from a social cognition perspective that emphasizes interpersonal and situational factors that can influence judgments. Consistent with that model, it organizes research findings into three broad domains that have been shown to systematically influence assessments of pain, involving patient, provider, and situational factors.

Results: A causal model for pain judgment is proposed, and its implications for clinical research and practice are explored.

Conclusions: In order to minimize the uncertainty that can characterize symptoms such as chronic pain, practitioners bring information to bear on pain assessment that can lead to misjudgments. While intuitively appealing, much of the information that is considered often has little association with pain severity and/or adjustment. A more rational decision-making process can reduce the judgment errors common to pain assessment and treatment.