Physician judgments and the burden of chronic pain

Abstract

Objective. In a moderated mediation model, this study examined the interaction effect of pain severity and medical evidence on physician judgments of chronic pain. The effects of higher pain severity on physician judgments were expected to be mediated through anticipated clinical burden, but only when medical evidence was low. Design. Participants were randomly assigned to one of six case descriptions of a chronic pain patient in a 3 3 2 design that varied by reported pain severity (4, 6, 8/10) and medical evidence (low vs high). Setting. An academic training program for medical residents/fellows. Subjects. Residents/fellows in clinical departments at postgraduate year 2 or higher (N=109). Methods. Participants read case descriptions and then made judgments about the patient and rated the level of burden they expected to assume in treating the patient. Results. Higher pain severity occasioned greater pain discounting and higher likelihood of prescribing opioid medication. When medical evidence was low, participants had less trust in the patient’s pain report, attributed pain more to psychosocial than medical factors, and were less likely to refer for possible surgery. Analyses yielded no support for moderated mediation as expected burden was high across all conditions. Significant associations were found between expected burden and multiple clinical judgments. Conclusions. Results did not support the proposed moderated mediation model as all patients were expected to be burdensome across clinical presentations, reflecting negative expectations of patients with chronic pain. Such expectations can have adverse implications for patient-provider communication, shared decision-making, and the delivery of personalized care.