How can we help patients with chronic pain? More empathy from doctors, to start | Opinion

Patients with chronic pain often feel marginalized when their symptoms are not explained by diagnostic tests and their physicians may appear powerless in treating them. The patient-physician relationship is crucial in these situations, and physician empathy enhances communication with patients.

The National Academy of Medicine estimated that more than 100 million Americans suffer from chronic pain, which may also affect their family and friends. The need for pain relief has contributed to the opioid crisis and prompted the Centers for Disease Control and Prevention to establish opioid prescribing guidelines.

The PRECISION Pain Research Registry at The University of North Texas Health Science Center at Fort Worth is uniquely positioned to study physician empathy among patients with chronic pain. It studies the patient-physician relationship using a digital research platform for electronic data capture throughout the United States.

The registry previously found that physician empathy is the strongest predictor of patient satisfaction with medical care for chronic pain. Empathy was more important than the pain outcomes that patients experienced or whether opioids were prescribed.

In the April 2024 issue of JAMA Network Open, the registry reported that patients treated by very empathic physicians had better outcomes than those treated by physicians with less empathy. Greater physician empathy was associated with less pain, more physical capabilities and better health-related quality of life over 12 months.

Nevertheless, research has shown that medical students and residents may become less empathic during their education and training. This is often attributed to a perceived need for objectivity in making medical decisions, ostensibly through patient detachment and reliance on technology. However, the incongruity between pain complaints and diagnostic imaging often renders decision-making problematic.

Current health care practices also present challenges in providing empathic care. These include factors such as long working hours, understaffing, limited time for patient encounters and administrative tasks involving electronic medical records documentation and insurance authorizations.

Research published in JAMA Internal Medicine reported measures of empathy in the responses to patient questions posted to a social media forum. A panel of health-care professionals rated the responses from an artificial intelligence chatbot assistant as having greater empathy than actual physician responses to the same questions.

So, what can be done to encourage more empathic health care for patients with chronic pain? Although there has been a long-standing debate about whether empathy is an inborn or acquired trait, most experts believe that medical students and physicians can be trained to be more empathic.

Researchers at the Harvard Medical School and Massachusetts General Hospital performed a randomized controlled trial, finding that residents in a variety of medical specialties became more empathic after participating in their training program. Although the program was brief and relatively simple, the authors cautioned that long-lasting improvements in empathic care could not be sustained without a commitment from institutional leaders.

The authors of “Compassionomics,” a New York Times best seller in health-care administration, compiled data from personal patient accounts and the biomedical literature on physician empathy and its actionable manifestation involving compassion. They showed that empathy has vast benefits in treating chronic pain and a variety of other conditions, including the potential to reverse burnout among health-care providers.

They also argued that health-care administrators should embrace empathy because it drives revenue and cuts costs. These claims are bolstered by our recent registry publication that reported greater physician empathy was associated with better chronic pain outcomes than costly, risky or invasive treatments such as nonpharmacological interventions, opioid therapy or lumbar spine surgery.

This emerging evidence heralds the concept of empathic health-care systems in which organizations are structured to facilitate empathic interactions throughout their services to treat chronic pain and other medical conditions.

This will undoubtedly require institutional policies and additional resources that enable health-care professionals and other employees to develop and cultivate empathy. However, the rewards may be well worth the effort.

Dr. John Licciardone is a regents professor and director of the PRECISION Pain Research Registry at The University of North Texas Health Science Center at Fort Worth.