Harmful words: a qualitative survey of pain clinicians’ perspectives on unhelpful messages in chronic pain

Review written by Dr Jarod Hall info

Key Points

  1. The language clinicians use with patients and the messages patients receive from the healthcare complex have the capacity to either be helpful or harmful to a patient’s perception of their issues and subsequent experience in recovery.
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BACKGROUND AND OBJECTIVE

Individuals living with chronic pain often report that they have had poor experiences of health care services. Research on the attitudes of clinicians and laypeople confirms that pain without a visible medical cause (Chronic Primary Pain) tends to be discounted in its validity and gravity (1,2). In particular, the pain invalidation literature has explored how chronic pain may be subject to disbelief, lack of compassion, lack of understanding and stigma (3).

Positively, a clinician’s pain validation and explanation associated with Pain Neuroscience Education (PNE) can be associated with improvements in pain, disability and fear of movement (4). However, negative effects are also common. For example, the perception of being invalidated by the clinician is associated with greater patient depression, shame and loneliness (5). The stigma that is consistently associated with chronic pain results in greater pain intensity, disability and depression.

No study to date has explored what clinicians see as the most unhelpful messages that have been received, or perceived, by their patients. Thus, this research study set out to survey specialist pain clinicians to establish and understand what unhelpful clinical messages their patients have experienced.

The pain invalidation literature has explored how chronic pain may be subject to disbelief, lack of compassion, lack of understanding and stigma.
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Plain, tailored explanations, ideally using patient-specific metaphors, can help reduce catastrophizing and support graded activity, whereas jargon, vagueness, and minimization often backfire.

METHODS

The study used a cross-sectional, online qualitative survey to capture clinicians’ descriptions of the unhelpful pain-related messages their patients bring into clinic. The authors worked from a critical-realist stance and analyzed responses with inductive Reflexive Thematic Analysis (Braun & Clarke),

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