Assessor status influences pain recall

Area of Science:

• Pain management and assessment
• Clinical psychology
• Medical sociology

Background:

• Patient pain reporting can be influenced by the perceived status of healthcare professionals.
• Delegating pain assessment to lower-status staff may introduce bias in clinical practice.

Purpose of the Study:

• To investigate the impact of assessor status on patient recall of pain intensity after a medical procedure.
• To determine if social dynamics in the physician-patient relationship affect pain reporting.

Main Methods:

• 70 low back pain patients rated pain and mood pre-procedure, post-procedure, and 2 weeks later.
• At 2-week follow-up, patients recalled their immediate post-procedure pain rating.
• Recall ratings were compared based on whether the initial rating was obtained by the treating physician or a research assistant.

Main Results:

• No significant differences in current pain or mood ratings were observed between groups at any time point.
• Patients' 2-week recall of immediate post-procedure pain was significantly lower when assessed by the physician compared to a research assistant.
• Recalled pain ratings were 86% higher when the initial assessment was conducted by a research assistant versus the physician.

Conclusions:

• A status-based bias exists in recalled pain reporting, where patients report lower pain when recalling interactions with higher-status physicians.
• This bias has significant implications for accurately assessing treatment effectiveness in clinical research and practice.
• Relying on recalled pain ratings may lead to underestimation of pain experiences, particularly when assessed by non-physician staff.