'The MRI-scan says it is completely normal': Reassurance attempts in clinical encounters among patients with chronic musculoskeletal pain

Abstract

In clinical guidelines for patients with chronic musculoskeletal pain, reassurance is a key element. The purpose of reassuring patients is to change their views on their illness and, thereby, their actions. However, when symptoms persist without pathological findings, reassurance can be difficult to achieve. Drawing on observations of nineteen naturally occurring hospital consultations with chronic musculoskeletal pain patients, followed by individual interviews with both patients and clinicians, we study how they interact in relation to reassurance. Our main aim is to explore the ways in which clinicians explicitly attempt to provide reassurance, and how patients receive these attempts, before reflecting on facilitating and hindering factors for successful reassurance in relation to the sociocultural context in which their interaction takes place. Through a thematic analysis, four dominating elements of explicit reassurance were identified: (1) education through visualisation, (2) validation through technological findings, (3) validation through physical examination and (4) normalising pain. To gain a deeper understanding of the reassurance process, we then narratively explored dialogical extracts containing these elements. The analysis shows a potential lack of congruence between what patients experience, and the biomedical knowledge clinicians rely on. Despite employing a combination of affective and cognitive modes of reassurance, clinicians tend to build their final conclusions not on patients experiences but on biomedical knowledge, which is knowledge that holds epistemic primacy for themselves. In that sense, their efforts to reassure the patients might also be a way in which they seek to reassure themselves.

Keywords: chronic pain; illness perception; patient-clinician communication; reassurance.

Figure 1.

Main components in reassurance attempts. Description: Overview of reassurance components and some key reassurance elements. Red squares indicate the most dominant and explicit reassurance elements. The significance and perception of each element can vary depending on the clinical context and interaction between the patient and clinician.”

Figure 2.

Types of visualisation. Description: The two drawings (a) were made by clinicians to illustrate things such as side effect and effect of medicine (upper left) and pain experience and brains signals (upper right). The MRI-scans (b) were utilised in educating patients about their spine. The herniated disc model (c) was used by clinicians to show what a herniated disc looks like and explain how it works.