How Much Do You Believe Someones Pain

Today's post from pain-topics.org (see link below) is a close examination of how we react to other people saying they are in pain. It's very easy to jump to the wrong conclusions based on our own assumptions and as we can never 'feel' someone else's pain directly, it's very easy to discount it or minimise it. the article is based on  Belgian studies and makes interesting reading for those who themselves have chronic pain issues and those around them who often react intuitively.

Pain Doubted if Medical Basis is Missing

Posted bySB. Leavitt, MA, PhD: Tuesday, December 11, 2012

Many chronic pain sufferers often feel that their maladies are misunderstood, disbelieved, or unaccepted by others. New research confirms that if there is no clear and convincing biomedical cause identified to satisfactorily explain the pain other people tend to discount it and have little sympathy toward the patient.

Researchers at Ghent University in Belgium conducted a pair of studies to investigate the impact of medical and psychosocial information on estimations of another person’s pain, along with observers’ emotional responses and their behavioral tendencies toward the person with pain [Ruddere et al. 2012]. Study participants were recruited from the community: Study 1: N = 29 women, 10 men; Study 2: N = 29 women, 12 men.

Participants variously viewed photographs of 4 alleged patients (2 men, 2 women; ages 44 to 57 years) described as having shoulder pain conditions. With each photograph there was a written brief vignette describing 2 of 4 different circumstances: either the presence or absence of a medical explanation for the pain, along with either the presence or absence of psychosocial influences attributed to the pain experience.

For example, pain was medically explained as associated with either “a little fracture,” “an inflammation,” or a “muscle strain”; in the no-cause condition the vignette simply stated that “based upon medical examination there appeared to be no injury to the shoulder.”
Psychosocial influences were described in Study 1 vignettes from the patients’ perspectives: eg, “[Fictitious patient name] reports having more pain when experiencing job stress” or “…more stress at home.” In Study 2, these influences were more authoritatively attributed to medical opinion: eg, “…the doctor decided that psychosocial factors have an impact upon the pain, in particular job stress and feelings of anxiety” or “…in particular relationship problems and a depressive mood.”

If psychosocial influences did not exist, in Study 1 they simply were not mentioned. In Study 2, however, there was a more explicit declaration that “…the doctor decided that psychosocial factors do not have an impact upon the pain.” Thus Study 1 and 2 were similar, except for a much stronger attribution of psychosocial factors, or lack thereof, in the second study.

After examining each vignette/photo, study participants were shown a brief video segment (8 seconds) displaying the respective patient having his/her shoulder examined and expressing facial signs of moderate pain. Then, on 4 different 100mm visual analog scales (VAS), participants rated each patient’s pain, their own distress upon viewing the patient in pain as well as their sympathy toward the patient, and their inclination to help the patient.

Writing in the December 2012 edition of the Journal of Pain, the researchers report that, in both Studies 1 and 2, results indicated significantly lower ratings on all measures when medical evidence for pain was absent. That is, when a medical explanation for a patient’s pain was missing, participants rated the pain as lower and their own distress at viewing the patient as lower, as well as less sympathy toward the patient and less willingness to help.

Surprisingly, there was no overall effect found on any of the 4 outcome measures due to claimed psychosocial influences on patients’ pain. The one small exception was in Study 2, in which participants indicated feeling less personal distress when psychosocial factors were explicitly indicated (ie, noted by examining physicians as having an impact).

The researchers conclude that the findings suggest pain is taken less seriously when there is no medical evidence to help explain it, and psychosocial influences on the patient — eg, stress at work or home, anxiety, relationship issues — are not considered as important contributors to pain. This line of investigation is important, the researchers note, for better understanding how patients’ pain for which there is no clear medical explanation is interpreted and judged by other persons.

COMMENTARY: Research in the social psychology field is often most interesting when it confirms — more or less scientifically — what most people already think they intuitively know. This present study confirms what many patients already have expressed in prior comments to various UPDATES articles; that is, when chronic pain is unexplained by a diagnosis of some severe biopathology patients often face significant obstacles to being taken seriously by their families, friends, and healthcare providers.

In the study by Ruddere et al. it was somewhat puzzling that psychosocial factors appeared to have so little influence on participants’ perceptions. It seemed that medical evidence for the pain superseded all other information when judging the genuineness of pain and consequent feelings of sympathy or helpfulness toward the patient.

As often is the case in the pain management field, more research is needed before leaping to any firm conclusions. For one thing, patients in the video segments displayed what had been determined as representing moderate pain; expressions of more severe pain might have had much greater impact on assessments — evoking higher ratings of pain (whether or not medically explained) and greater empathy by study participants.

Another important limitation was that participants had no personal relationships or direct interactions with the fictitious patients; completely unlike what would be the case in clinical settings or among family/friends. Essentially, the researchers attempted to create a laboratory setting for assessing human variables that are far more complex in everyday life or clinical practice.
Participant-group sizes — Group 1, N= 39; Group 2, N=41 — were probably adequate to provide reasonable statistical power for detecting significant differences, avoiding Type II (false negative) findings. [Readers should note that numbers of participants indicated in the study abstract and the article text itself are grossly discordant; we are using numbers from the text.]

However, composition of the participant groups must be considered: overall, the two groups were unequally balanced toward women, average participant age was significantly lower than the test patients (roughly 28 vs 51 years), and approximately half of participants were college students. So, generalizing the findings at this time to how older persons, healthcare providers, or family/friends might react could be erroneous.

Therefore, there are still unanswered questions about how the qualities of patients and those interacting with them, as well as available information about patient medical condition and/or psychosocial influences, affect judgments when it comes to pain assessment, sympathy, and helping behavior. The researchers, themselves, acknowledge most of these limitations; yet, this study is an important step toward a better understanding of several factors that might significantly bias perceptions of patients’ pain and impact the care that they receive in medical settings and at home.

REFERENCE: Ruddere LD, Goubert L, Vervoort T, et al. We Discount the Pain of Others When Pain Has No Medical Explanation. J Pain. 2012(Dec);13(12):1198-1205

http://updates.pain-topics.org/2012/12/pain-doubted-if-medical-basis-is-missing.html

 

HOME TEST FOR TOO MUCH CAFFEINE

The shocking news of an Ohio teen who died of a caffeine overdose in May highlighted the potential dangers of the normally well-tolerated and mass-consumed substance. To help prevent serious health problems that can arise from consuming too much caffeine, scientists are reporting progress toward a rapid, at-home test to detect even low levels of the stimulant in most beverages and even breast milk. Their report appears in ACS' Journal of Agricultural and Food Chemistry

Mani Subramanian and colleagues note that caffeine's popularity as a "pick-me-up" has led to it being added to more than 570 beverages and 150 food products, including gums and jelly beans. It also comes in a pure powder form that consumers can use themselves to spike drinks and food. In small amounts, most people can handle caffeine without a problem. But excessive doses can lead to serious health problems, including insomnia, hallucinations, vitamin deficiency, several types of cancer and in rare cases, death. Subramanian's team wanted to develop a quick and easy way for consumers to determine whether the caffeine levels in their foods and drinks fall within a safe range.

They tested an enzyme called caffeine dehydrogenase and found that it could detect caffeine in a variety of drinks -- with the exception of teas -- within one minute. Also, it was sensitive enough to pick up on caffeine's presence at concentrations as low as 1 to 5 parts per million, the maximum limit the Food and Drug Administration advises for nursing mothers. They say that their method could be integrated into a dip-stick type of test, like over-the-counter pregnancy tests, that could be used at home.

DRINKING TOO MUCH WATER CAN BE FATAL TO ATHLETES

The recent deaths of two high school football players illustrate the dangers of drinking too much water and sports drinks, according to Loyola University Medical Center sports medicine physician Dr. James Winger.

Over-hydration by athletes is called exercise-associated hyponatremia. It occurs when athletes drink even when they are not thirsty. Drinking too much during exercise can overwhelm the body's ability to remove water. The sodium content of blood is diluted to abnormally low levels. Cells absorb excess water, which can cause swelling -- most dangerously in the brain.

Hyponatremia can cause muscle cramps, nausea, vomiting, seizures, unconsciousness, and, in rare cases, death.

Georgia football player Zyrees Oliver reportedly drank 2 gallons of water and 2 gallons of a sports drink. He collapsed at home after football practice, and died later at a hospital. In Mississippi, Walker Wilbank was taken to the hospital during the second half of a game after vomiting and complaining of a leg cramp. He had a seizure in the emergency room and later died. A doctor confirmed he had exercise-associated hyponatremia.

And in recent years, there have been more than a dozen documented and suspected runners' deaths from hyponatremia.

Winger said it's common for coaches to encourage athletes to drink profusely, before they get thirsty. But he noted that expert guidelines recommend athletes drink only when thirsty. Winger said athletes should not drink a predetermined amount, or try to get ahead of their thirst.

Drinking only when thirsty can cause mild dehydration. "However, the risks associated with dehydration are small," Winger said. "No one has died on sports fields from dehydration, and the adverse effects of mild dehydration are questionable. But athletes, on rare occasions, have died from over-hydration."

Winger is co-author of a 2011 study that found that nearly half of Chicago-area recreational runners surveyed may be drinking too much fluid during races. Winger and colleagues found that, contrary to expert guidelines, 36.5 percent of runners drink according to a present schedule or to maintain a certain body weight and 8.9 percent drink as much as possible.

"Many athletes hold unscientific views regarding the benefits of different hydration practices," Winger and colleagues concluded. Their study was published in the British Journal of Sports Medicine.