Patients Are Socially Excluded When Their Pain Has No Medical Explanation

Abstract

This study investigated whether observers socially exclude patients who experience pain that is not medically explained by means of an experimental design. Fifty-nine participants (individuals from the general population) viewed videos of 4 patients, each accompanied by a vignette describing the presence or absence of a medical explanation for their pain. Participants estimated patient's pain, and rated the sympathy felt for and the inclination to help the patient.In order to measure social exclusion, participants indicated their willingness to interact with the patients in several situations (Social Distance Scale). Furthermore, the participants were invited to select two of the four patients as confederates to play a game against another duo. When no medical explanation for the pain was provided, participants attributed less pain, reported feeling less sympathy and were less inclined to help the patients with daily activities. Of particular importance to this study, participants were less willing to interact with patients with medically unexplained pain and selected less often patients with 'medically unexplained' pain than patients with 'medically explained' pain as confederates in the social game. These results are indicative of social exclusion of patients with pain for which there is no clear medical explanation.Perspective: Observers socially exclude patients with pain for which there is no clear medical explanation. These findings have important clinical implications. In particular, social exclusion might have detrimental effects on both the mental and physical wellbeing of patients with pain.

Adult attachment insecurity is positively associated with medically unexplained chronic pain

“…For example, the experience of chronic pain is associated with a decline in relationship functioning (Mohamed et al, 1978), which could in turn lead to greater attachment insecurity. Given that people with medically unexplained pain tend to be evaluated more negatively by others than do people with pain with a known cause (De Ruddere et al, 2016), those with MUCP in this study may be particularly likely to experience relationship difficulties that lead to lowered levels of attachment security.…”

Pain as a threat to the social self: a motivational account

“…23,72,107 Individuals with chronic pain are more socially isolated and excluded than healthy controls across the lifespan, 33,70,74 especially when pain has no medical explanation. 76 Although it has been argued that one of the "key objects of fear" in chronic pain is threat to self-identity, 64 this threat also directly affects the "social self." 86 Individuals with chronic pain internalize stigma regarding alienation and discrimination.…”

Conceptualizing pain-related stigma in adolescent chronic pain: a literature review and preliminary focus group findings

“…Likewise, the difficulty in diagnosing the cause for chronic pain can lead medical providers to question the veracity of pain reports. Many chronic pain conditions do not present with clear medical etiology and may thus prompt medical providers to interpret symptoms as either “real” or “fake.” 7 The biomedical model that dominates medical practice has led to dualistic views of chronic pain symptoms, declaring them as either “medical” or “psychological” conditions. For some providers, only medical symptoms (not psychological) are viewed to be “real”; such attitudes among medical providers may indicate a fundamental lack of understanding of the complexities of chronic pain and its determinants.…”

“…Social isolation experienced by adolescents with chronic pain is common due to functional impairment secondary to disease, 14 yet disbelief of pain symptoms exacerbates the social disruption and disease-related burden in this young population. Research indicates that social exclusion may occur when there is a perception that an individual has medically unexplained pain, 7 as these youth are suspected of attention seeking. Social support buffers adolescents with chronic pain from negative health outcomes.…”