Judgments about pain intensity and pain genuineness: the role of pain behavior and judgmental heuristics.

Department of Psychology, McGill University, Montreal, Canada.
The journal of pain: official journal of the American Pain Society (Impact Factor: 3.78). 02/2011; 12(4):468-75. DOI: 10.1016/j.jpain.2010.10.010
Source: PubMed

ABSTRACT The primary objective of the present study was to examine the relative importance of pain behaviors and judgmental heuristics (eg, gender stereotypes) in observers' inferences about pain intensity and pain genuineness. Participants (n = 90) observed video depictions of chronic pain patients performing a physically challenging task and were asked to make inferences of pain intensity and pain genuineness. Analyses indicated that observers relied on judgmental heuristics and pain behaviors both when making inferences about pain intensity and when making inferences about pain genuineness. Follow-up analyses, however, revealed that judgmental heuristics (eg, gender stereotypes) were significantly less utilized when observers made inferences about pain genuineness than when observers made inferences about pain intensity. When observers made inferences about pain genuineness, analyses indicated that patients' facial pain behaviors became the most important source of information. Taken together, these findings suggest that observers who are asked to make inferences about the genuineness of others' pain are likely to reduce their reliance on judgmental heuristics in favor of more controlled and thoughtful inferential processes characterized by detailed processing of behavioral information, particularly others' facial pain behaviors. PERSPECTIVE: The current study provides new insights into the processes that are involved in observers' inferences about pain intensity and pain genuineness. These inferences play an important role in treatment decisions and advances in this domain could ultimately contribute to more effective management of the challenges facing patients with pain-related disorders.

  • [Show abstract] [Hide abstract]
    ABSTRACT: CONTEXT: Pain is a common and complex experience for individuals who live with multiple sclerosis (MS) and it interferes with physical, psychological, and social function. A valid and reliable tool for quantifying observed pain behaviors in MS is critical to understand how pain behaviors contribute to pain-related disability in this clinical population. OBJECTIVES: To evaluate the reliability and validity of a pain behavioral observation protocol in individuals who have MS. METHODS: Community-dwelling volunteers with MS (N=30), back pain (N=5), or arthritis (N=8) were recruited based on clinician referrals, advertisements, fliers, web postings, and participation in previous research. Participants completed the measures of pain severity, pain interference, and self-reported pain behaviors and were videotaped doing typical activities (e.g., walking and sitting). Two coders independently recorded frequencies of pain behaviors by category (e.g., guarding and bracing) and interrater reliability statistics were calculated. Naïve observers reviewed videotapes of individuals with MS and rated their pain. The Spearman's correlations were calculated between pain behavior frequencies and self-reported pain and pain ratings by naïve observers. RESULTS: Interrater reliability estimates indicated the reliability of pain codes in the MS sample. Kappa coefficients ranged from moderate (sighing=0.40) to substantial agreements (guarding=0.83). These values were comparable with those obtained in the combined back pain and arthritis sample. Concurrent validity was supported by correlations with self-reported pain (0.46-0.53) and with self-reports of pain behaviors (0.58). Construct validity was supported by finding of 0.87 correlation between total pain behaviors observed by coders and mean pain ratings by naïve observers. CONCLUSION: Results support the use of the pain behavior observation protocol for assessing pain behaviors of individuals with MS. Valid assessments of pain behaviors of individuals with MS could lead to creative interventions in the management of chronic pain in this population.
    Journal of pain and symptom management 11/2012; · 2.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Demographic characteristics have been found to influence pain management decisions, but limited focus has been placed on participants' reactions to feedback about their use of sex, race, or age to make these decisions. The present study aimed to examine the effects of providing feedback about demographic cue use to participants making pain decisions. Participants (n=107) viewed 32 virtual human (VH) patients with standardized levels of pain, and provided ratings for VHs' pain intensity and their treatment decisions. Real-time LENS model idiographic analyses determined participants' decision policies based on cues used. Participants were subsequently informed about cue use and completed feedback questions. Frequency analyses were conducted on responses to these questions. Between 7.4%-89.4% of participants indicated awareness of their demographic or pain expression cue use. Of those individuals, 26.9%-55.5% believed this awareness would change their future clinical decisions, and 66.6%-75.9% endorsed that their attitudes affect their imagined clinical practice. Between 66.6%-79.1% of participants who used cues reported willingness to complete an online tutorial about pain across demographic groups. This study was novel because it provided participants feedback about their cue use. Most participants who used cues indicated willingness to complete in an online intervention, suggesting this technology's utility for modifying biases.
    Journal of Pain 08/2014; · 3.24 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In the present study, participants (ie, observers) watched video sequences of patients with chronic back pain performing a physically demanding lifting task. Participants were asked to make judgments about patients' levels of pain and readiness to work. For each patient, observers were also asked to make judgments about personality traits relevant to work performance and employment. The primary objective of this study was to examine the differential influence of communicative and protective pain behaviors on observers' judgments about patients' pain intensity and readiness to work. Consistent with previous research, analyses indicated that patients displaying either communicative (eg, facial expressions) or protective (eg, guarding) pain behaviors were perceived as having significantly more pain than patients displaying no pain behavior. Analyses also revealed that patients displaying protective pain behaviors were perceived as being significantly less likable, less dependable, and less ready to work than patients displaying other forms of pain behavior. Discussion addresses the processes by which pain behaviors might influence observers' judgments about patients' personality traits and readiness to work. Implications of the present findings for clinical practice and the management of patients presenting with pain conditions are also discussed.
    Pain 02/2012; 153(4):843-9. · 5.64 Impact Factor

Full-text (2 Sources)

Available from
Sep 18, 2014