Is clinician empathy the new painkiller for chronic pain patients?

Clinician empathy could be a key pain reliever for patients experiencing chronic pain, with a recent study in JAMA Network Open outlining how greater perceptions of empathy from their physicians were linked to lower reported pain levels.

To be clear, empathy doesn’t have the same physiological effects as taking ibuprofen or other pain medicine. But in the chronic pain space, where patient-reported outcomes are key, patients with a better relationship with a provider they think is empathic may be more likely to discuss their pain levels. That opens fresh doors for reconsidering pain management and treatment, the researchers indicated.

Researching clinician empathy is complex work, the researchers said in their study introduction. Empathy itself is a subjective matter, and it’s hard to quantify the effect an empathic patient-provider relationship can have on the patient, especially the clinical outcomes most health systems are focused on improving.

But pain management is one area that could open itself to a better understanding of how empathy affects outcomes.

“The patient-physician relationship is vital among patients with chronic low back pain (CLBP) because patients often feel isolated, misunderstood, or stigmatized when an underlying cause of pain cannot be identified,” the researchers explained.

Some early evidence has suggested patients who perceive their providers to be more empathic tend to have better outcomes.

This latest study corroborated that, finding that patients getting treated by providers deemed more empathic had lower reported pain levels.

Using data from the Consultation and Relational Empathy measure, clinicians were segmented into two groups: very empathic physician (VEP) and slightly empathic physician (SEP). The team then looked at the self-reported pain levels of the 1,470 CLBP patients who interacted with those physicians.

Patients who visited with very empathic physicians had lower mean pain intensity (6.3 versus 6.7 on a 10-point scale) and less mean back-related disability (14.9 versus 16.8 on a 24-point scale). They were also less likely to report fatigue.

These outcomes underscore the positive impact empathy can have on the patient-provider relationship, the researchers said. Indeed, empathy doesn’t act like a painkiller. Rather, it allows patients to trust their clinicians, which can lead to more fruitful conversations around symptoms and lifestyle that can ultimately inform treatment decisions.

“Patients who somatize their chronic pain may be more likely to discuss psychosocial issues with VEPs, thereby directing diagnostic and therapeutic efforts down more rewarding paths that enhance compliance and outcomes,” the researchers explained.

Still, empathy in medicine is a complex issue, with many industry experts even questioning whether it can or should be taught.

“Medical students and residents often become less empathic during education and training, owing to a greater perceived need for patient detachment and reliance on technology,” the research team said. “The challenges of contemporary medicine, including electronic medical records and time constraints, may also contribute to an erosion of empathy among seasoned physicians.”

Still, the data are clear: empathy can enhance the patient-provider relationship, and that can result in better clinical outcomes, the researchers stressed.

“An aspirational view is that empathy should not be limited to individual practitioners but should be incorporated within the broader domain of health care systems,” they concluded. “Such systems would be structured and organized to facilitate empathic health care delivery using macro-level decisions involving political and jurisdictional considerations.”