Abstract
This study examined symptom judgments made by medical students of hypothetical chronic low back pain patients. Eight vignettes were varied as to the pain intensity reported by the hypothetical patient (low vs. moderate vs. high vs. very high) and the availability of medical evidence supportive of the pain report (present vs. absent). Ninety-five subjects read vignettes and made judgments of patient emotional distress, pain intensity, and pain-related disability. Subjects significantly discounted pain level when intensity was high but slightly augmented pain level when intensity was low. Judgments of pain and disability were higher for patients for whom medical evidence was present compared to those for whom it was absent. The results support and extend previous research on the effects of situational and patient variables on observer pain judgments. Future research should examine the influence of these biasing variables on the assessment and treatment of chronic pain patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Bondestam, E., Hovgren, K., Johansson, F. G., Jern, S., Herlitz, J., and Holmberg, S. (1987). Pain assessment by patients and nurses in the early phase of acute myocardial infarction. J. Adv. Nurs. 12: 677–682.
Carey, T. S., Hadler, N. M., Gillings, D., Stinnett, S., and Wallsten, T. (1988). Medical disability assessment of the back pain patient for the Social Security Administration: The weighting of presenting clinical features. J. Clin. Epidem. 41: 691–697.
Chibnall, J. T., and Tait, R. C. (1994). The Pain Disability Index: Factor structure and normative data. Arch. Phys. Med. Rehab. 75: 1082–1086.
Chibnall, J. T., and Tait, R. C. (1995). Observer perceptions of low back pain: Effects of pain report and other contextual factors. J. Appl. Soc. Psychol. 25: 418–439.
Evans, R. W., Evans, R. I., and Sharp, M. J. (1994). The physician survey on the post-concussion and whiplash syndromes. Headache 34: 268–274.
Goldman, B. (1991). Chronic-pain patients must cope with chronic lack of physician understanding. Can. Med. Assoc. J. 144: 1492–1497.
Grossman, S. A., Sheidler, V. R., Swedeen, K., Mucenski, J., and Piantadosi, S. (1991). Correlation of patient and caregiver ratings of cancer pain. J. Pain Symp. Manage. 6: 53–57.
Hadler, N. M. (1984). Medical Management of the Regional Musculoskeletal Diseases: Backache, Neck Pain, and Disorders of the Upper and Lower Extremities, Grune and Stratton, New York.
Jensen, M. P., Karoly, P., and Braver, S. (1986). The measurement of clinical pain intensity: A comparison of six methods. Pain 27: 117–126.
McDonald, D. D., and Bridge, R. G. (1991). Gender stereotyping and nursing care. Res. Nurs. Health 14: 373–378.
Ong, L. M. L., de Haes, J. C. J. M., Hoos, A. M., and Lammes, F. B. (1995). Doctor-patient communication: A review of the literature. Soc. Sci. Med. 40: 903–918.
Reid, J., Ewan, C., and Lowy, E. (1991). Pilgrimage of pain: The illness experiences of women with repetition strain injury and the search for credibility. Soc. Sci. Med. 32: 601–612.
Rudy, T. E., Turk, D. C., and Brena, S. F. (1988). Differential utility of medical procedures in the assessment of chronic pain patients. Pain 34: 53–60.
Tait, R. C., and Chibnall, J. T. (1994). Observer perceptions of chronic low back pain. J. Appl. Soc. Psychol. 24: 415–431.
Tait, R. C., and Chibnall, J. T. (1997). Symptom judgments in patients with intractable pain. Adv. Med. Psychother. (in press).
Tait, R. C., Chibnall, J. T., and Krause, S. J. (1990). The Pain Disability Index: Psychometric properties. Pain 40: 171–182.
Todd, K. H., Lee, T., and Hoffman, J. R. (1994). The effect of ethnicity on physician estimates of pain severity in patients with isolated extremity trauma. JAMA 271: 925–928.
Weighill, V. E. (1983). “Compensation neurosis”: A review of the literature. J. Psychosom. Res. 27: 97–104.
Zalon, M. L. (1993). Nurses' assessment of postoperative patients' pain. Pain 54: 329–334.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Chibnall, J.T., Tait, R.C. & Ross, L.R. The Effects of Medical Evidence and Pain Intensity on Medical Student Judgments of Chronic Pain Patients. J Behav Med 20, 257–271 (1997). https://doi.org/10.1023/A:1025504827787
Issue Date:
DOI: https://doi.org/10.1023/A:1025504827787