Does trusting your doctor help reduce pain because your doctor is more like you, or a friend, or shares your religious beliefs, cultural values, race, ethnicity or other things that connect you to others?
A newly published study in the Journal of Pain about feelings of clinician-patient trust kind of put this premise to the test – or at least let us explore and think about this more closely.
The researchers who published the study simulated clinician-patient interactions to uncover social and cultural factors that influence the pain people experience when visiting their doctors. The goal was to find ways to help people feel less pain when seeing a doctor, as well as, reduce phobias that can amplify pain.
On the surface, this appears to relate more directly to those who experience, or anticipate, acute pain vs. those who suffer from chronic pain, but the study does not make that differentiating point; hence this editorial comment.
Dr. Elizabeth Losin, assistant professor of psychology at the University of Miami College of Arts and Sciences; Steven Anderson, a University of Miami graduate student in the Department of Psychology; and Tor Wager, Ph.D., Professor in the Institute of Cognitive Science at the University of Colorado Boulder, were inspired by published literature about patients that report higher levels of satisfaction with care if they are racially or ethnically close to their caregivers.
“Pain also has a psychological component as well, and it’s the interaction between the psychological and physiological aspects of pain that we’re really interested in,” Dr. Losin said.
Dr. Losin also noted that physician-patient interactions are typically fast and superficial so people often don’t actually get the time to figure out whether they have anything in common with their doctor.
“You go to the doctor’s office and you have to get a procedure that is painful and scary,” said Losin. “We want to know how the doctor-patient dynamic, in this case how the doctor and patient perceive one another, might affect how much pain the patient feels from that painful medical procedure. If the patient feels they have something in common with their doctor, is that enough to actually change how much pain they feel?”
The researchers used a modified version of a “minimal group paradigm,” which is normally used in social psychology experiments to create artificial groups in the lab based on something completely arbitrary and superficial. This approach allows researchers to figure out the minimal conditions required for real-world intergroup behavior, like discrimination, to occur.
But, in this study the groups were created differently.
“We created the groups based on participants’ core personal beliefs and values, the same things that we think doctors and patients infer based on race and ethnicity in the context of medical care,” Losin said. “We gave participants a questionnaire that asked about their political ideology, religious and gender role beliefs and practices. When they came into the lab, we separated the participants into two groups and told them they were assigned to these groups based on their questionnaire answers but not giving specifics to which question put them there.”
The goal was to to make people from the same group believe they had something in common. The thought was that this may manifest itself as more positive feeling, like trust, towards participants playing the role of the doctor or the patient from their own group.
During the simulated clinical interaction, the doctors performed a pain-induction procedure on the patients by applying heat to their inner forearm, meant to simulate a painful medical procedure like a shot.
“After the interaction, we asked both the doctor and the patient how similar they felt to each other and how much they trusted each other,” said Losin. “We predicted that patients would report being in less pain when they had a doctor from their own group than a doctor from the other group. We also expected less pain if the patients trusted their doctor more and felt more similar to them.”
The findings of the study show that the more patients reported trusting their doctor and feeling similar to them, the less pain they reported feeling. The study also suggest that those who experience higher levels of anxiety on a day-to-day basis experienced greater reductions in pain from feeling close to their doctor.
“Overall, we are interpreting our findings as suggesting that the doctor is essentially acting as a social placebo, playing the same role that a sugar pill would play if we were doing a study on placebo pain relief,” Dr Losin noted. “When someone believes that something is going to help relieve their pain, their brain naturally releases pain-relieving chemicals. Our hypothesis, based on what we are seeing, is that trusting and feeling similar to the doctor who is performing the painful procedure is creating that same kind of placebo pain relief.”
Ultimately, the researchers would like to use the results of her studies to design and test new methods clinicians can use during the doctor-patient interaction to build trust and help decrease pain for their patients.
The findings did not tease out the potential influence of like-minded and culturally similar doctor-patient experiences as they relate to chronic vs. acute pain. But it should not be discounted that these findings may relate to either circumstance.
The study is entitled, “Feelings of clinician-patient similarity and trust influence pain: Evidence from simulated clinical interactions,” was published in the Journal of Pain, the official journal of the American Pain Society.