Invalidation in Patients with Rheumatic Diseases: Clinical and Psychological Framework

Santiago, Mariana; Marques, Andréa; Kool, Marianne B.; Geenen, Rinie; Silva, José António Pereira da

doi:10.3899/jrheum.160559

Cited by 35 publications

(33 citation statements)

References 22 publications

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“…Santiago et al found that invalidation occurred in all rheumatic diseases with psychological factors, loneliness and pain intensity associated with invalidation and deserving of dedicated intervention. 16 Our initial research is in agreement with previous research that the reliance amongst many HCPs on often inconclusive test results rather than considering subjective symptoms can leave many patients feeling disbelieved and dismissed. 17,18,19 Price and Walker found that for some the SLE diagnostic journey often has no satisfying conclusion and can be an iatrogenic experience with the journey to diagnosis mirroring the disease in terms of ambiguity and chaos.…”

supporting

confidence: 90%

Exploring the views and impact of peer support and helping with research into their own diseases, using email support groups, on patients with lupus and related autoimmune diseases

Sloan¹

2020

http://isrctn.com/

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supporting

confidence: 90%

Exploring the views and impact of peer support and helping with research into their own diseases, using email support groups, on patients with lupus and related autoimmune diseases

Sloan¹

2020

http://isrctn.com/

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“…32,35,66 In line with recent conceptualizations, (mis)attribution of pain as psychological in nature could be considered a form of discounting. 39 Defined by Kool and colleagues 39 as a type of invalidation, discounting responses to pain have been shown to negatively impact the physical and emotional health of individuals with pain conditions, particularly fibromyalgia 25,65 which is known to be more prevalent in women. 80 Our findings, despite their relatively smaller effect sizes, align with those from non-pain studies in which women are more likely to have their physical symptoms dismissed as psychological reactions.…”

Section: Discussionmentioning

confidence: 99%

Differential Effect of Patient Weight on Pain-Related Judgements About Male and Female Chronic Low Back Pain Patients

Miller

Allison

Trost

et al. 2018

The Journal of Pain

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Compared to men, women report more pain and are at increased risk for having pain discounted or misattributed to psychological causes. Overweight individuals experience high rates of pain and may receive suboptimal care due to provider bias. Research suggests the social consequences of being overweight are worse for women than men, and that gender and weight uniquely and interactively impact pain experience and care. Healthy participants (N=616) viewed six videos of back pain patients (1 female and 1 male of normal-weight, overweight, and obese categories) performing a functional task. Participants provided judgments/ratings regarding patient pain (intensity, interference, exaggeration), potential sources of patient pain (medical, psychological), and treatment recommendations (opioids, psychological therapy, seek workplace accommodations). Results suggest that the pain of normal and overweight women and obese men was discounted (judged as less intense, less interfering, more exaggerated, and less attributable to medical factors) and judged as less in need of treatment (treated with less opioids and workplace accommodations). Across all weight categories, women's pain was attributed more to psychological factors and was more likely to receive recommendations for psychological therapy than men's pain. These findings highlight the differential impact of patient weight on painrelated judgments about women and men.Keywords: obesity, weight, gender, chronic low back pain, pain assessment, pain treatment Perspective: This article examines the relationships among patient weight, patient gender, and observers' pain appraisals and treatment recommendations. These findings highlight the differential impact of patient weight on pain-related judgments about women and men and indicate the need for research to determine how these judgments affect treatment decisions in clinical settings.

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“…The term “invalidation” is used to describe the patients' perception that their illness and symptoms is not recognized by their social environment [ 24 ]. Although invalidation is not exclusive to FM patients and also affects other rheumatic diseases, it most often perceived and expressed by FM patients [ 25 26 ]. Practicing clinicians are often confronted with a high prevalence of invalidation in FM patients.…”

Section: Main Bodymentioning

confidence: 99%

Challenges in fibromyalgia diagnosis: from meaning of symptoms to fibromyalgia labeling

2018

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Fibromyalgia (FM) is a contested illness with ill-defined boundaries. There is no clearly defined cut-point that separates FM from non-FM. Diagnosis of FM has been faced with several challenges that occur, including patients' health care-seeking behavior, symptoms recognition, and FM labeling by physicians. This review focuses on important but less visible factors that have a profound influence on under- or over-diagnosis of FM. FM shows different phenotypes and disease expression in patients and even in one patient over time. Psychosocial and cultural factors seem to be a contemporary ferment in FM which play a major role in physician diagnosis even more than having severe symptom levels in FM patients. Although the FM criteria are the only current methods which can be used for classification of FM patients in surveys, research, and clinical settings, there are several key pieces missing in the fibromyalgia diagnostic puzzle, such as invalidation, psychosocial factors, and heterogeneous disease expression. Regarding the complex nature of FM, as well as the arbitrary and illusory constructs of the existing FM criteria, FM diagnosis frequently fails to provide a clinical diagnosis fit to reality. A physicians' judgment, obtained in real communicative environments with patients, beyond the existing constructional scores, seems the only reliable way for more valid diagnoses. It plays a pivotal role in the meaning and conceptualization of symptoms and psychosocial factors, making diagnoses and labeling of FM. It is better to see FM as a whole, not as a medical specialty or constructional scores.

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Invalidation in Patients with Rheumatic Diseases: Clinical and Psychological Framework

Cited by 35 publications

References 22 publications

Exploring the views and impact of peer support and helping with research into their own diseases, using email support groups, on patients with lupus and related autoimmune diseases

Exploring the views and impact of peer support and helping with research into their own diseases, using email support groups, on patients with lupus and related autoimmune diseases

Differential Effect of Patient Weight on Pain-Related Judgements About Male and Female Chronic Low Back Pain Patients

Challenges in fibromyalgia diagnosis: from meaning of symptoms to fibromyalgia labeling

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