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Design and Participants: This cohort study (including Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation enrollees) measured the association of physician empathy with pain, function, and health-related quality of life (HRQOL) among adults with chronic back pain. The Consultation and Relational Empathy measure assessed empathy, which was dichotomized to yield very and slightly empathic physician groups. Outcomes were patient-reported pain, function, and HRQOL measured via a numerical rating scale for pain intensity, the Roland-Morris Disability Questionnaire, and the Patient-Reported Outcomes Measurement Information System for HRQOL deficits pertaining to anxiety, depression, fatigue, sleep disturbance, and pain interference (PI). Data were collected at 5 quarterly encounters (enrollment through 1 year) and analyzed with generalized estimating equations, including multivariable models to measure temporal trends and to adjust for baseline and longitudinal covariates.
Results: Patients (N=1,470) were aged mean 53 years (SD=13); were 74% female; and were 1.4% American Indian/Alaska Native, 2.0% Asian, 17% Black/African American, less than 1% Pacific Islander, and 79% White. Greater empathy was inversely associated with pain intensity (β=−0.01; 95% CI=−0.02 to −0.01), disability (β=−0.06; −0.09 to −0.04), and HRQOL deficits on each measure (PI: β=−0.08; −0.11 to −0.05). Compared to slightly empathic, the very empathic group reported lower pain intensity (mean=6.3; 95% CI=6.1-6.5 vs 6.7; 6.5-6.9), less disability (15; 14-16 vs 17; 16-18), and fewer HRQOL deficits on each measure (fatigue: 57; 56-59 vs 60; 59-62). All group differences were clinically relevant, with Cohen d statistics ranging from 0.21 for pain intensity to 0.30 for disability, fatigue, and PI.
Commentary: This cohort study demonstrates a significant correlation between physician empathy and improved clinical outcomes in patients with chronic back pain. Patients who perceived higher levels of empathy from their physicians reported lower pain intensity, reduced disability, and fewer health-related quality of life issues than those with less empathic physicians. The study’s strengths include using a national registry for diverse recruitment, longitudinal follow-up over 12 months to track outcome changes, and robust adjustment for potential confounders through multivariable analysis. Limitations such as volunteer bias in registry participation, exclusion of non–English speakers affecting generalizability, and lack of detailed physician and clinical setting data were noted. Despite these constraints, the findings underscore empathy as pivotal in enhancing patient well-being and advocate for its integration as a therapeutic tool in chronic pain management, aiming to enhance healthcare quality through improved patient–provider interactions.
Bottom Line: Empathic communication can have positive impacts on chronic back pain outcomes, aligning with prior research emphasizing the importance of empathy in medical practice.
Reviewer: Ramandeep Kaur, MD MHA HMDC FAAHPM, Rush University Medical Center, Chicago, IL
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Source: Licciardone JC, Tran Y, Ngo K, Toledo D, Peddireddy N, Aryal S. Physician empathy and chronic pain outcomes. JAMA Netw Open. 2024;7(4):e246026. doi:10.1001/jamanetworkopen.2024.6026.
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