Provider Judgments of Patients in Pain: Seeking Symptom Certainty
Article first published online: 5 NOV 2008
© American Academy of Pain Medicine
Volume 10, Issue 1, pages 11–34, January/February 2009
How to Cite
Tait, R. C., Chibnall, J. T. and Kalauokalani, D. (2009), Provider Judgments of Patients in Pain: Seeking Symptom Certainty. Pain Medicine, 10: 11–34. doi: 10.1111/j.1526-4637.2008.00527.x
- Issue published online: 31 JAN 2009
- Article first published online: 5 NOV 2008
- Pain Assessment;
- Social Cognition;
- Chronic Pain
Objective. Uncertainty often surrounds judgments of pain, especially when pain is chronic. In order to simplify their decisions, providers adduce information from a variety of sources. Unfortunately, an extensive literature suggests that the information that is brought to bear actually can bias pain judgments, resulting in judgments that consistently differ from patient reports, with a potential negative impact on treatment.
Methods. This review examines the pain assessment literature from a social cognition perspective that emphasizes interpersonal and situational factors that can influence judgments. Consistent with that model, it organizes research findings into three broad domains that have been shown to systematically influence assessments of pain, involving patient, provider, and situational factors.
Results. A causal model for pain judgment is proposed, and its implications for clinical research and practice are explored.
Conclusions. In order to minimize the uncertainty that can characterize symptoms such as chronic pain, practitioners bring information to bear on pain assessment that can lead to misjudgments. While intuitively appealing, much of the information that is considered often has little association with pain severity and/or adjustment. A more rational decision-making process can reduce the judgment errors common to pain assessment and treatment.