Observer Perceptions of Low Back Pain: Effects of Pain Report and Other Contextual Factors1


  • 1

    The authors express their appreciation to an anonymous reviewer for insightful comments made on an earlier draft of this manuscript.

Correspondence concerning this article should be addressed to John T. Chibnall, Saint Louis University Medical Center, Division of Behavioral Medicine, 1221 South Grand Boulevard, St. Louis, MO 63104.


This study examined the impact of reported pain level (low vs. high) and three other contextual factors on observers' perceptions of the symptoms and personality of persons with chronic low back pain. In addition to pain level, the availability of medical evidence, the valence of the relationship between the observer and the person in pain, and the amount of control the person in pain had over circumstances of pain onset were varied in a 2 × (2 × 2 × 2) mixed experimental design. Eighty undergraduate subjects read descriptions of hypothetical persons with chronic low back pain and then estimated the amount of pain, disability, and emotional distress they would expect the person to manifest. Subjects also described the target person's personality using 10 semantic differential scales. Significant main effects for medical evidence, relationship valence, and control emerged for personality ratings of adjustment, character, and judgment. Main effects emerged for medical evidence, relationship valence, and pain level on ratings of pain, disability, and distress. Significant two-way, three-way, and four-way interactions also were found for symptom ratings. The results indicate that perceptions of chronic pain are sensitive to contextual factors, potentially biasing the assessment of persons with pain as a primary complaint.