Physician Empathy and Chronic Pain Outcomes

Abstract

Importance: Empathy is an aspect of the patient-physician relationship that may be particularly important in patients with chronic pain.

Objective: To measure the association of physician empathy with pain, function, and health-related quality of life (HRQOL) among patients with chronic low back pain.

Design, setting, and participants: This cohort study included adult enrollees from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation national pain research registry. Study dates were from April 1, 2016, to July 25, 2023, with up to 12 months of follow-up.

Exposure: Physician empathy was assessed with the Consultation and Relational Empathy measure and dichotomized to yield very empathic physician and slightly empathic physician groups.

Main outcomes and measures: Main outcomes were patient-reported pain, function, and HRQOL measured with a numerical rating scale for low back pain intensity, the Roland-Morris Disability Questionnaire for back-related disability, and the Patient-Reported Outcomes Measurement Information System for HRQOL deficits pertaining to anxiety, depression, fatigue, sleep disturbance, and pain interference. Data were collected at 5 quarterly encounters from registry enrollment through 12 months and analyzed with generalized estimating equations, including multivariable models to measure temporal trends and to adjust for baseline and longitudinal covariates.

Results: Among the 1470 patients, the mean (SD) age was 53.1 (13.2) years, and 1093 (74.4%) were female. Patients completed 5943 encounters in which multivariable analyses demonstrated that greater physician empathy was inversely associated with pain intensity (β = -0.014; 95% CI, -0.022 to -0.006; P < .001), back-related disability (β = -0.062; 95% CI, -0.085 to -0.040; P < .001), and HRQOL deficits on each measure (eg, pain interference: β = -0.080; 95% CI, -0.111 to -0.049; P < .001). Correspondingly, compared with the slightly empathic physician group, the very empathic physician group reported lower mean pain intensity (6.3; 95% CI, 6.1-6.5 vs 6.7; 95% CI, 6.5-6.9; P < .001), less mean back-related disability (14.9; 95% CI, 14.2-15.6 vs 16.8; 95% CI, 16.0-17.6; P < .001), and fewer HRQOL deficits on each measure (eg, fatigue: 57.3; 95% CI, 56.1-58.5 vs 60.4; 95% CI, 59.0-61.7; P < .001). All physician empathy group differences were clinically relevant, with Cohen d statistics ranging from 0.21 for pain intensity to 0.30 for back-related disability, fatigue, and pain interference. Physician empathy was associated with more favorable outcomes than non-pharmacological treatments, opioid therapy, and lumbar spine surgery.

Conclusions and relevance: In this cohort study of adult patients with chronic pain, physician empathy was associated with better outcomes over 12 months. Greater efforts to cultivate and improve physician empathy appear warranted.

Figure 1.. Pain and Function Outcomes Over Time

A, Measured with a numerical rating scale for the typical pain level in the 7 days prior to each encounter, with scores ranging from 0 to 10. B, Measured with the Roland-Morris Disability Questionnaire, with scores ranging from 0 to 24. Higher scores on both assessments indicate worse outcomes for pain and function. Physicians were classified as very empathic if their Consultation and Relational Empathy (CARE) measure scores were 30 or higher and as slightly empathic if their scores were 29 or lower. Scores range from 10 to 50, with higher scores indicating greater physician empathy. Slightly empathic physicians made up approximately the lowest quartile on the CARE measure. Summary measures and P values are for the entire 12-month period adjusted for time and empathy × time interaction. Error bars represent 95% CIs. SEP indicates slightly empathic physician; VEP, very empathic physician.

Figure 2.. Health-Related Quality-of-Life Outcomes Over Time

Health-related quality of life was measured using the Patient-Reported Outcomes Measurement Information System with 29 items. Each deficit measure included 4 ordinal-scale items that were scored and normed according to the US general population to yield mean (SD) scores of 50 (10). The sole exception was sleep disturbance, which was normed using a calibration sample enriched with patients having chronic illness. Higher scores indicate worse outcomes. Physicians were classified as very empathic if their Consultation and Relational Empathy (CARE) measure scores were 30 or higher and as slightly empathic if their scores were 29 or lower. Scores ranged from 10 to 50, with higher scores indicating greater physician empathy. Slightly empathic physicians made up approximately the lowest quartile on the CARE measure. Summary measures and P values are for the entire 12-month period adjusted for time and empathy × time interaction. Error bars represent 95% CIs. SEP indicates slightly empathic physician; VEP, very empathic physician.