Abstract
Complex factors influence how people report and interpret numerical pain ratings. Such variability can introduce noise and systematic bias into clinical pain assessment. Identification of factors that influence self-rated pain and its interpretation by others may bolster utility of these scales. In this qualitative study, 338 participants described motivations for modulating their own pain reports relative to a numerical pain scale (0–10), as well as perceptions of others’ pain reporting modulation. Responses indicated that people over-report pain to enhance provider belief/responsiveness or the likelihood of pain relief, and out of fear of future pain or potential illness. Concerns of how one’s pain affects and is perceived by others, and financial concerns motivated pain under-reporting. Unprompted, many participants reported never modulating their pain ratings, citing trust in providers and personal ethics. Similar reasons were assumed to motivate others’ pain ratings. However, participants often attributed others’ over-reporting to internal causes, and their own to external. This bias may underlie common assumptions that patients over-report pain for nefarious reasons, distort interpretation of pain reports, and contribute to pain invalidation. Recognition of patient concerns and one’s own personal biases toward others’ pain reporting may improve patient-provider trust and support precision of numerical pain ratings.
Highlights
IntroductionClinical pain assessment relies upon self-report measures – often using numerical pain ratings.These measures are valid, reliable, and easy to use (Hjermstad et al, 2011); numerical pain ratings fail to convey the complex nature of the pain experience (Wideman et al, 2019), and some researchers have questioned the unidimensional nature and utility of pain ratings used in Influences Behind Pain Rating Modulation likely reinforce pain stigma more generally (Goldberg, 2017).open-ended assessment of more general lay-beliefs about others’ pain reporting motivations is currently missing from the literature.Identification of the motivations involved in pain reporting behavior through the use of numerical pain ratings and assumptions of the pain reporting motives of others is expected to support increased precision and utility of these scales
Participants were recruited and compensated using TurkPrime’s ( CloudResearch) Panels1 (Litman et al, 2016; we recently described the advantages of this recruitment method in Mathur et al, 2020)
The authors are interested in understanding individual factors that contribute to pain experiences, and recognize that they may be biased toward supporting the Multiple common themes arose for why participants had previously underor over-reported their pain in clinical settings
Summary
Clinical pain assessment relies upon self-report measures – often using numerical pain ratings.These measures are valid, reliable, and easy to use (Hjermstad et al, 2011); numerical pain ratings fail to convey the complex nature of the pain experience (Wideman et al, 2019), and some researchers have questioned the unidimensional nature and utility of pain ratings used in Influences Behind Pain Rating Modulation likely reinforce pain stigma more generally (Goldberg, 2017).open-ended assessment of more general lay-beliefs about others’ pain reporting motivations is currently missing from the literature.Identification of the motivations involved in pain reporting behavior through the use of numerical pain ratings and assumptions of the pain reporting motives of others is expected to support increased precision and utility of these scales. Clinical pain assessment relies upon self-report measures – often using numerical pain ratings. Prior qualitative studies have been constrained to samples of people with a shared clinical diagnosis, and have not assessed common cultural norms and behaviors within the general population. In this exploratory study, we examined self-reported motivations for why people over- and/or under-report their own pain, as well as their perceptions of others’
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