The downgrading of pain sufferers’ credibility

Abstract

Background The evaluation of pain remains one of the most difficult challenges that healthcare practitioners face. Chronic pain appears to affect more than 35% of the population in the West, and indeed, pain is the most common reason patients seek medical care. Despite its ubiquity, studies in the last decades reveal that many patients feel their pain is dismissed by healthcare practitioners and that, as a result, they are denied proper medical care. Buchman, Ho, and Goldberg (J Bioethic Inq 14:31-42, 2017) point to this phenomenon as a form of “epistemic injustice”: an unfair and harmful downgrading of credibility affecting some individuals and groups, which prevents them from receiving appropriate and beneficial medical care. Methods By exploring the existing literature on this downgrading of patients’ credibility written by healthcare professionals and scholars in medical humanities, I identify and examine the reasons patients are often not believed about their pain and why healthcare is too-often unhelpful or hurtful to people presenting with chronic pain. I also explore to what extent it is possible to forge an alternative epistemological model. Results I suggest that most of the causes of this downgrading of patient’s credibility result from either the difficulty in communicating pain or the widespread belief that pathology is always the result of objective tissue damage. I examine whether pain has to be effectively communicated and have an objective cause in order for it to be deemed credible. In the end, I argue that in the case of pain, both communication and objectivity are highly problematic. Conclusions I conclude by suggesting that, although alternative epistemological models might be impossible to build, believing patients has both moral and clinical benefits, and this warrants further research.

Experiences of Patients Living with Retrograde Cricopharyngeal Dysfunction

“…Patient invalidation by the medical community represents a significant barrier to diagnosis and obtaining patient trust as demonstrated in other at-risk populations, including patients with chronic pain, fibromyalgia, and patients who identify as sexual and gender minorities. 21,23,24 A feature of this study is that a lack of diagnosis in participants interviewed resulted in potentially harmful or maladaptive behaviors to alleviate their RCPD symptoms. The impact of self-treatment is amplified as there is a risk of self-misdiagnosis when there is no connection to a physician to guide management.…”

Pain: The Silent Public Health Epidemic

“… 37 It may not be easy to find a clinician who truly understands the patient’s suffering. 38 For example, a patient’s pain complaint should never be dismissed or judged. Even if the etiology of the pain is determined to be emotional or psychic, the patient’s suffering should always be considered valid by the treating clinician.…”

“…Even if the etiology of the pain is determined to be emotional or psychic, the patient’s suffering should always be considered valid by the treating clinician. 38 Chronic pain has both sociological and scientific definitions. Margo McCaffrey, RN, a visionary in pain medicine who died in 2018, stated in the mid-1960’s that pain is “whatever the experiencing person says it is, existing whenever and wherever the person says it does.” 39 Developing a therapeutic alliance, therefore, can improve pain outcomes and help patients with chronic pain feel trusted.…”

Communicating the experience of living with chronic pain: The role of non-verbal communication and the power of lessons learned

“…Often, patients use language and metaphoric expressions that provide rich descriptions of sensations but do little to help providers with diagnosis (Jairath, 1999). Many individuals with chronic pain complain of not being believed and that doubt and skepticism are common responses to their pain disclosures; ultimately, credibility is at the crux of the issue (Tosas, 2021;. The words and performative work needed to represent pain are frequently met with disbelief by healthcare providers and this experience of invalidation causes feelings of stigma and isolation among chronic pain sufferers (Tosas, 2021).…”