If You Trust Your Doc, Does It Reduce Pain?

If You Trust Your Doc, Does It Reduce Pain?

By Staff.

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.

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Authored by: Staff

There are 14 comments for this article
  1. Jean Price at 4:04 pm

    Hmm…”simulated clinician patient interactions” when considering a painful office procedure! Okay, has the world gone TOTALLY CRAZY?! Or is it just me? I don’t see the relationship to daily, life limiting pain and a one time painful procedure! And I also don’t see why this was elevated to the status of an article here… nor why I wasted my time even reading it…let alone replying! Ugh! Dumb!

  2. Janet Komanchuk at 9:41 am

    I had a great relationship with my family doctor. He always listened. He always tried to find an alternative—adjusting prescription dosages, prescribing a different medication, offering a referral to yet another specialist. When, in spite of his help, I still suffered chronic pain and sought alternative and complementary treatments he never made me feel like my pain was “all in my head, a woman thing,” as previous physicians had. His support certainly helped alleviate rather than exacerbate my anxieties. So grateful to have finally found the alternative wellness work that resulted in my remission.

  3. Denise Bault at 5:32 am

    Leah, you are absolutely right! It’s all about the money…sad, but true. Our current President is trying to appease the insurance companies – huge lobbyists, by the way – and millions of Americans will be going without coverage. They want to roll things back to pre-Obamacare days when the insurance companies could pick and choose clients. Those that had pre-existing conditions are priced out of the marketplace, thus increasing profit for the health insurance companies. Unconscionable! Please let your representatives know how you feel, because it only takes one illness or one change in employment or divorce to throw you out of the insurance marketplace. ONE DAY IT COULD BE YOU OR A LOVED ONE!

  4. Mark Ibsen at 8:29 pm

    I used to make his declaration of my patients:
    ” I will stand by you until your restored to previous level of health”
    I cannot.
    They trusted me.
    Now I have been sidelined.
    They have been betrayed.
    If you like and trust your doctor
    It
    Is
    Likely
    Someone Will be threatened by that and take some administrative action against you.

  5. Cherylmarie at 6:18 pm

    In the ER I have to frequent sometimes there is a physcian working there and I can be in the worst pain and he still can make me laugh and smile. He is the kindest, most compassionate doctor I have ever been treated by in an ER. He treats me as a someone needing help, not a “chronic pain patient”. I have left the ER in tears before because of the demeaning and disrespectful manner I was treated by other providers. Fortunately I was able to honor that doctor with a little presentation they allow patients and families to show their appreciation and read a letter I wrote. I don’t think physicians fully realize what an impact they can make on you, positive or negative.

  6. Leah at 5:20 pm

    Pharmacist Steve, I remember you. You’re absolutely right on the money. And when I see a doctor for anything my anxiety increases 100%. Why bother? Stress and anxiety contribute to cancer. I’m taking Kratom. I feel just fine and I don’t care if I have cancer. I will deal with it when I have to. The care in the United States for chronic pain is nonexistent and becoming so more every day. How many vets have committed suicide? How many people have committed suicide? But that’s what our president wants. My parents survived the Holocaust. I am here to experience almost the same thing in a more subtle way.

  7. Sandrag at 5:19 pm

    Kimberley did you say you have a fantastic relationship with your family doctor, but he doesn’t reduce your pain. How can that be fantastic ?

    Denise we have man studies on chronic pain , but they pick and choose what they want to believe for their own needs met whether it b money political favors ect. They live on th edge of truth.
    Sandrag
    Like a man keeps telling me you want to solve this Vote the Bums out and tell them why you are voting for others and not them. No quick fixes so start now send letters and phone calls many of them get others have a letter writing party with cookies..

  8. Leah at 5:17 pm

    Kimberly, you’re in Canada. It’s very different here in the United States. Because of all the laws and the CDC. We don’t get treatment like that. The physicians here fear that their license will be revoked if they give us anything outside of one weeks’ worth of pain medication even after surgery. I have had oral cancer and recurring dysplasia four times. Each time I have had several wide area excisions on the tongue, posterior area, behind the left molar, into the buccal tissue left cheek. I cannot explain to you the pain even after the doctor removed tissue from the buccal area which she did not mention to me before or after the surgery. I was in so much pain I lost 25 pounds because the salt and the pain I could not take it. I found out that there was no squamous cell carcinoma in that area where she did a vertical wide area excision on my buccal tissue left cheek. It was painful, it was infected and I had a fever. The pain was excruciating not to mention the other wide area excisions. I am 4 miles from the CDC. Do you honestly think I’m going to get the pain medication I need? No. This surgeon saw me neither before or after surgery. I reported her to the AMA and they did nothing. I saw supposedly a doctor two weeks after and it was not a doctor but her nurse. She totally denied everything to the physicians advocate at Emory. I had to have more pain killer because you have no idea how many nerves there are in the tongue. The doctor started calling me an addict. She denied care and forced the entire ear nose and throat group to throw me out with the bathwater. That’s how much I think of our system here. I probably have cancer now because I have not been seen for it in years. I did see one ear nose and throat doctor and he told me himself the doctor I saw was horrible. That she had horrible bedside manners and he had many of her patients because of that. I no longer have an ear nose and throat doctor because why? I can’t afford surgery and even if I could do it because of the pain and the lack of narcotics I won’t do it. The area is swollen and I have all the symptoms again. I’m not having surgery because I cannot have the pain relief I need. Therefore I’m going to die. That’s with the CDC has dictated. People will die or commit suicide. I am actively seeking euthanasia. This country sickens me. I don’t want to live anymore.

  9. Pharmacist Steve at 2:05 pm

    It was once believed in dealing with the pain of cancer pts.. that once you proved to them that you could reduce their pain and at least make the pain bearable.. that a reduction in pain medication could be done without increasing their pain levels, because – it was surmised – that it reduced their anxiety… which was partially contributing to their pain levels. From a Psychological perspective, it only makes sense that if a pt believes/feels that the healthcare provider is doing everything they can to help the pt… their anxiety will most likely be reduced. With a chronic pain pt… there is no “getting rid of their pain”… there is only lowering the intensity of their pain. All to often, the healthcare provider doesn’t have an initial conversation with the chronic pain pt as to what their expectation of where they think that the intensity of their pain can be reduced to.. if the pt’s expectation is unrealistic… their anxiety component of their pain will never be resolved.

  10. M at 12:15 pm

    Anyone knows that pain is increased by stress. I would think the more logical conclusion to this “test” is that for *that moment, that instant* they were less stressful and it wouldn’t be gender or ethnicity related.

    It would have absolutely no impact unless that doctor or set of “companionable” people in the group were to be with the patient forever, 24/7. The patient would leave that test and return to insanity. (or whatever they knew prior to that meeting)

  11. Ibin Aiken at 9:23 am

    When awakened out of finally attained sleep for chronic pain patients, it really at that point does not matter whether you and your physician have anything in common or trust one another. Unfortunately the goal for the awakening in the “wee” hours of the morning is to reduce pain so as not to be alert the rest of the night. Some of us……still work. Pain can be bad enough to hamper your working, social life and it can be totally disabling. . I happen to trust my pain management doctor. which does make scheduled appointments much less stressful. I have had only two different physicians in 23 years treatment for failed back surgeries. It is comforting to be able to relate to your doctor but, after all they are very much restrained as to “how much” they can do. I have eat a ton of kratom,. ( not FDA approved) tried several brands of CBD oil, (no THC as it is not legal), and spent much money in the attempt to find a “natural” non pharmaceutical pain reliever. I have been self employed for almost forty years and thrive on self-reliance. Many factors are relevant to chronic pain but, there are proven pain relievers although pharma oriented, do work. I have broken no laws in reference to schedule one substances, do not abuse or re-distribute my personal medication yet that does not prevent government from further trying to control the way I think. Another organization can not control the way an individuals’ thoughts yet government WILL control the collective if it kills you.

  12. Denise Bault at 7:57 am

    Why not do a study for those of us in CHRONIC pain?

  13. Leah at 5:11 am

    No. I don’t feel comfortable with my doctor. If anything I feel more stressed out. Why? Because I was forced on Medicare after a retired traffic policeman hit me while bicycling. Disabled and unemployed I had my own business, but now I can’t do anything. The doctors I want to see don’t take Medicare! Therefore, I have seen a plethora of doctors as PCPs neurologists and more. One of them refused to put my shoulder back in after I had vertigo, from a concussion related to the accident, and fell on it because it was already separated from the accident. This doctor told me he was afraid to put it back in for fear of nerve damage. I asked him for some pain relief and went home, read about it, put it back myself! When I visited him again he told me ..sure enough I had fixed it. Sheer incompetence or just don’t care attitude. I’m just another number. They don’t want to prescribe anything for my pain long term which I already know and they can’t even think of anything that would help me so I have to tell them what about acupuncture? Well duh…. but, Medicare will not pay for that and I don’t have the money. So no. Only Cadillac insurance will get you a decent doctor. Why don’t you talk about that? Insurance is a business. They are just in it for the MONEY! How many people feel comfortable with their Medicare or Medicaid doctors? Why don’t you ask about that? I want to ask how many people feel like committing suicide because they are in pain and can’t do anything about it? Why don’t you ask how many people don’t have the money to afford decent insurance? I find these question of yours to be sophomoric. Tackle the real issues first. There are two classes of insurance: rich and poor. Our president wants to kill people. Pre-existing conditions may cost more or may not be covered. Why don’t we discuss that? Why not discuss how many people will die without expensive insurance? How many people are worried their insurance won’t pay everything or they will be wiped out if they have a significant medical issue? What about deductibles? What about co-pays? Only the rich survive!

  14. Kimberly Soloway at 3:37 am

    I have a fantastic relationship with my family doctor. I don’t think it reduces my pain, but it certainly helps my anxieties and my fears as I know I have a doctor who will do everything he can to help me with my health issues. I couldn’t ask for a better family doc and the office staff are wonderful as well. Shout out to Ravine Medical Clinic. Edmonton, Alberta 🇨🇦

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