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NEW YORK, April 11 (UPI) -- Physician empathy is an important aspect in a doctor-patient relationship, and now it has been linked to better outcomes among people with chronic pain, a new study finds. The study, led by The University of North Texas Health Science Center at Fort Worth, was published Thursday in JAMA Network Open.
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Patients under the care of very empathic physicians reported experiencing much better and clinically relevant outcomes related to pain, function and health-related quality of life over 12 months compared with those managed by slightly empathic physicians.
Physician empathy was more strongly associated with favorable outcomes than nonpharmacological treatments, opioid therapy and lumbar spine surgery, the researchers noted.
"Greater efforts to cultivate and improve physician empathy appear warranted," they wrote, noting that "physician empathy may enhance patient adherence to treatment and improve clinical outcomes."
The researchers also pointed out that "the patient-physician relationship is fundamental to the practice of medicine. Although there is no agreement on how to define or study empathy, empathic opportunities arising during medical encounters may be missed, thereby posing a threat to the patient-physician relationship."
However, studies of physician empathy typically depend on observational research. They involve physician self-assessed empathy or patient-perceived empathy.
The current study included 1,470 participants -- more than 74% female -- who completed 5,943 research encounters at quarterly intervals over 12 months.
They were enrolled in the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) from April 1, 2016 to July 25, 2023. This registry offers screening throughout the contiguous United States using social media advertising.
"We established this national pain research registry in 2016. We collect quite a bit of data on patients in the registry with chronic pain," the study's lead author, Dr. John Licciardone, Regents professor at The University of North Texas Health Science Center, said in a telephone interview.
Participants were eligible for the study if they were between 21 to 79 years old, experienced chronic low back pain for at least three months, had a physician who provided usual care for this condition, and possessed sufficient English-language proficiency to complete case report forms.
Pregnant women and residents of an institutional facility were ineligible.
Physician empathy is vital among patients with chronic low back pain because there often isn't an identified underlying reason if X-rays and exams can't point to anything abnormal, said Licciardone, a clinical epidemiologist certified in public health and preventive medicine.
It's not surprising then, he added, that many patients with chronic pain feel like they aren't taken seriously.
"There's no objective evidence on diagnostic tests to explain why they have chronic pain," Licciardone said.
"In that case, the interaction with the doctor becomes much more important. When patients have an empathic doctor that they can relate better with, they're more likely to have adherence to their treatment plan and to follow their doctor's advice, so that usually leads to better outcomes."
"This study adds meaningfully to research on the relationship between physician empathy and outcomes in patients with chronic low back pain," said David Cates, vice chair of clinical operations in the psychiatry department at University of Nebraska Medical Center in Omaha, who was not involved in the research.
"The relatively long (12-month) follow-up period and the use of patient ratings of physician empathy, in particular, add value to this study," said Cates, who also is director of behavioral health at Nebraska Medicine.
People can sense when health care providers put themselves in their patients' shoes, listening in a nonjudgmental way and with an open mind. It helps them heal and reduces their pain, said Dr. Kimberly Mauer, medical director of the Comprehensive Pain Center at Oregon Health & Science University in Portland.
"Physician empathy has a substantial effect on patient's pain. So often these days, patients tell us that they wonder if people believe them about the suffering they are experiencing," said Mauer, who is also a professor of anesthesiology and perioperative medicine. "I believe that they feel this way because we don't have objective ways to measure pain intensity."
Several questions remain unanswered in this study, such as whether a patient perceives a doctor to be more empathetic for fulfilling a request even if it's clinically unfounded, said Dr. Charles Odonkor, an assistant professor of orthopedics and rehabilitation at Yale School of Medicine in New Haven, Conn.
On the other hand, a patient may leave the doctor's office angry if a physician refuses to prescribe opioids for chronic pain despite expressing empathy and explaining why the drugs "might not be such a good idea," said Odonkor, who also is a Yale Medicine interventional pain specialist.
It's likely that patients suffering from chronic low back pain have tried multiple strategies and consulted with several providers before seeing a surgeon, said Dr. Timothy Chryssikos, a neurosurgeon at the University of Maryland Medical Center in Baltimore.
Beyond the technical success of an appropriate surgery, a patient's perception of physician empathy may influence how well that person feels afterward, said Chryssikos, who is also an assistant professor at the University of Maryland School of Medicine.
Recognizing that each patient is unique, he strives to pay close attention to everyone's story, understanding an individual's goals in his or her own words.
"Often, they are things we take for granted," Chryssikos said, "such as 'I'd like to be able to walk to the mailbox' or 'I'd like to sit without pain.' This study reminds us all to always put the patient first."
