Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-18T14:46:12.861Z Has data issue: false hasContentIssue false
  • English
  • Français

Empathy and the failure to treat pain

Published online by Cambridge University Press:  22 May 2007

STEVEN D. PASSIK ,
KAREN BYERS  and
KENNETH L. KIRSH
STEVEN D. PASSIK
Affiliation:
Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
KAREN BYERS
Affiliation:
Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
KENNETH L. KIRSH
Affiliation:
Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky
Get access Rights & Permissions [Opens in a new window]

Abstract

We set out to discuss the psychological barriers that exist in the treatment of pain. Specifically, we argue that clinicians have several innate mechanisms at play that can hinder their judgment and lead to erroneous assumptions about their patients. Issues are discussed from social psychological and psychodynamic perspectives. A focus is placed on the issue of empathy and how this, too, can act as a barrier to rational judgment when evaluating patients. In the face of growing scrutiny on pain management in the United States, it is important to understand the barriers to providing care that already exist on an intrinsic level. Through the exploration of these barriers, clinicians might be better able to reflect on their own practice. Ultimately, we hope to push forward an agenda of rational therapy in pain management that utilizes safeguards against abuse and addiction while also preserving treatment modalities for patients in need of services.

Keywords

PainEmpathyUndertreatmentBarriers
Type
COMMENTARY
Information
Palliative & Supportive Care , Volume 5 , Issue 2 , June 2007 , pp. 167 - 172
Copyright
© 2007 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Balkrishnan, R., Hall, M.A., Mehrabi, D., et al. (2002). Capitation payment, length of visit, and preventive services: Evidence from a national sample of outpatient physicians. American Journal of Managed Care, 8, 332–340.Google Scholar
Beresford, T.P., Blow, F.C., Hill, E., et al. (1990). Comparison of CAGE questionnaire and computer-assisted laboratory profiles in screening for covert alcoholism. Lancet, 336, 482–485.Google Scholar
Breitbart, W., Passik, S., McDonald, M.V., et al. (1998). Patient-related barriers to pain management in ambulatory AIDS patients. Pain, 76, 9–16.Google Scholar
Butler, S.F., Budman, S.H., Fernandez, K., et al. (2004). Validation of a screener and opioid assessment measure for patients with chronic pain. Pain, 112, 65–75.Google Scholar
Cleeland, C.S. (1998). Undertreatment of cancer pain in elderly patients. Journal of the American Medical Association, 279, 1914–1915.Google Scholar
Cleeland, C.S., Gonin, R., Baez, L., et al. (1997). Pain and treatment of pain in minority patients with cancer. The Eastern Cooperative Oncology Group Minority Outpatient Pain Study. Annals of Internal Medicine, 127, 813–816.Google Scholar
Correll, J., Park, B., Judd, C.M., et al. (2002). The police officer's dilemma: Using ethnicity to disambiguate potentially threatening individuals. Journal of Personality and Social Psychology, 83, 1314–1329.Google Scholar
Fisch, M.J., Titzer, M.L., Kristeller, J.L., et al. (2003). Assessment of quality of life in outpatients with advanced cancer: The accuracy of clinician estimations and the relevance of spiritual well-being—A Hoosier Oncology Group Study. Journal of Clinical Oncology, 21, 2754–2759.Google Scholar
Friedman, R., Li, V., & Mehrotra, D. (2003). Treating pain patients at risk: Evaluation of a screening tool in opioid-treated pain patients with and without addiction. Pain Medicine, 4, 182–185.Google Scholar
Gati, I. & Tversky, A. (1984). Weighting common and distinctive features in perceptual and conceptual judgments. Cognitive Psychology, 16, 341–370.Google Scholar
Gavin, D.R., Ross, H.E., & Skinner, H.A. (1989). Diagnostic validity of the drug abuse screening test in the assessment of DSM-III drug disorders. British Journal of Addiction, 84, 301–307.Google Scholar
Grossman, S.A., Sheidler, V.R., Swedeen, K., et al. (1991). Correlation of patient and caregiver ratings of cancer pain. Journal of Pain and Symptom Management, 6, 53–57.Google Scholar
Haro, J.M., Kontodimas, S., Negrin, M.A., et al. (2006). Methodological aspects in the assessment of treatment effects in observational health outcomes studies. Applied Health Economics and Health Policy, 5, 11–25.Google Scholar
Hay, J. & Passik, S.D. (2000). The cancer patient with borderline personality disorder: Suggestions for symptom-focused management in the medical setting. Psycho-Oncology, 9, 91–100.Google Scholar
Johnson-Laird, P.N., Girotto, V., & Legrenzi, P. (2004). Reasoning from inconsistency to consistency. Psychology Review, 111, 640–661.Google Scholar
Joranson, D.E. (1994). Are health-care reimbursement policies a barrier to acute and cancer pain management? Journal of Pain and Symptom Management, 9, 244–253.Google Scholar
Kahneman, D. (2003). A perspective on judgment and choice: Mapping bounded rationality. American Psychologist, 58, 697–720.Google Scholar
Kahneman, D. & Tversky, A. (1996). On the reality of cognitive illusions. Psychology Review, 103, 582–591; discussion 592–596.Google Scholar
Marcus, E.R. (2003). Medical student dreams about medical school: The unconscious developmental process of becoming a physician. International Journal of Psychoanalysis, 84, 367–386.Google Scholar
McDonald, M., Passik, S.D., Dugan, W., et al. (1999). Nurses' recognition of depression in their patients with cancer. Oncology Nursing Forum, 3, 593–599.Google Scholar
Mechanic, D., McAlpine, D.D., & Rosenthal, M. (2001). Are patients' office visits with physicians getting shorter? New England Journal of Medicine, 344, 198–204.Google Scholar
Ohtaki, S., Ohtaki, T., & Fetters, M.D. (2003). Doctor–patient communication: A comparison of the USA and Japan. Family Practice, 20, 276–282.Google Scholar
Passik, S.D. & Kirsh, K.L. (2006). Fear and loathing in the pain clinic. Pain Medicine, 7, 363–364.Google Scholar
Passik, S.D., Kirsh, K.L., Whitcomb, L.A., et al. (2004). A new tool to assess and document pain outcomes in chronic pain patients receiving opioid therapy. Clinical Therapeutics, 26, 552–561.Google Scholar
Passik, S.D., Kirsh, K.L., Whitcomb, L.A., et al. (2005). Monitoring outcomes during long-term opioid therapy for non-cancer pain: Results with the pain assessment and documentation tool. Journal of Opioid Management, 1, 257–266.Google Scholar
Passik, S.D., McDonald, M., Dugan, W., et al. (1998). Oncologists' recognition of depression in their patients with cancer. Journal of Clinical Oncology, 16, 1594–1600.Google Scholar
Perry, S.W. (1984). Undermedication for pain on a burn unit. General Hospital Psychiatry, 6, 308–316.Google Scholar
Perry, S.W. (1985). Irrational attitudes toward addicts and narcotics. Bulletin of New York Academy of Medicine, 61, 706–727.Google Scholar
Redelmeier, D.A., Koehler, D.J., Liberman, V., et al. (1995). Probability judgement in medicine: Discounting unspecified possibilities. Medical Decision Making, 15, 227–230.Google Scholar
Rizq, R. (2005). Ripley's Game: Projective identification, emotional engagement, and the counselling psychologist. Psychology and Psychotherapy, 78, 449–464.Google Scholar
Todd, K.H., Samaroo, N., & Hoffman, J.R. (1993). Ethnicity as a risk factor for inadequate emergency department analgesia. Journal of American Medical Association, 269, 1537–1539.Google Scholar
Ward, S.E., Goldberg, N., Miller-McCauley, V., et al. (1993). Patient-related barriers to management of cancer pain. Pain, 52, 319–324.Google Scholar
Waska, R. (2006). Addictions and the quest to control the object. American Journal of Psychoanalysis, 66, 43–62.Google Scholar
Webster, L.R. & Webster, R.M. (2005). Predicting aberrant behaviors in opioid-treated patients: Preliminary validation of the Opioid Risk Tool. Pain Medicine, 6, 432–442.Google Scholar
Winnicott, D.W. (1960). Counter-transference. III. British Journal of Medical Psychology, 33, 17–21.Google Scholar
Woloschuk, W., Harasym, P.H., & Temple, W. (2004). Attitude change during medical school: A cohort study. Medical Education, 38, 522–534.Google Scholar
Yahav, R. & Oz, S. (2006). The relevance of psychodynamic psychotherapy to understanding therapist–patient sexual abuse and treatment of survivors. Journal of the American Academy of Psychoanalytic Dynamic Psychiatry, 34, 303–331.Google Scholar