May-05-2014

The problem of chronic pain: Don’t stop believin’

Chronic pain is real, and patients rarely 'fake" it.

Chronic pain is real, and patients rarely ‘fake” it.

 

Because chronic pain is an “invisible” disability, one of the biggest challenges faced by patients with chronic pain is having their pain taken seriously and believed, both by health professionals and the general public. When medical tests reveal no identifiable organic cause for their pain, patients are told that they exaggerating or that the pain is “all in their head.”

Computers reading faces better than people?

A recent paper found that a computer program was better able to detect faked facial expressions of pain in patients than human adult observers (who generally fare no better than chance). The results of this paper have generated considerable media attention, including headline stories in major news outlets proclaiming “Computers Can Tell If You’re Really in Pain—Even Better Than People Can.” The New York Times even created an interactive web post about this work in which their readers can view patient videos and try to guess for themselves whether the patient is faking pain or not (“Are These People in Real Pain or Just Faking It?”).

The underlying assumption and message behind these media stories is dangerous.

Myth of people “faking pain”

It promotes the widespread misbelief held by the general public and many health professionals that chronic pain patients are faking their pain. This simply isn’t the case.

Chronic pain is a serious health issue that is estimated to affect 1-in-5 adults and children. The U.S. Institute of Medicine estimates that chronic pain costs more to society than cancer and heart disease combined. Chronic pain is also associated with significant disability and suffering. Unfortunately, many patients with pain never gain access to the expert pain management they need, and, for those who do, existing treatments are far from curative.

Chronic pain is a serious and poorly understood health problem. It’s recognized as a disease in and of itself, regardless of whether it is associated with another known medical condition or not.

Chronic pain and patients need respect

In order to improve pain management and ensure patients with pain get access to the pain care they deserve, we need more health professionals who are educated about pain and believe in their patients, not more suspicions of faking. Deliberate feigning of pain by patients (both adults and children) is extremely rare. Far more common is the problem of chronic pain patients with serious and debilitating pain conditions not being believed and being told that the pain is “all in their head.”

The feeling of not having their pain taken seriously leads many patients with chronic pain to become demoralized as a result of their interactions with health professionals, insurance companies, legal professionals, and even their family and friends, which further adds to their suffering.

Research shows children rarely fake pain

In our research examining genuine, faked, and suppressed expressions of pain in children, children reported rarely ever deliberately faking pain, but they often reported hiding or suppressing pain, because they didn’t want to worry their parents or stop what they were doing. And parents in our study were far more likely to miss suppressed expressions of pain in their children than they did faked expressions.

Pain assessment with patients is challenging. And if, as this research shows, a computer can help improve pain assessment, this is worth pursuing. But let’s just make sure the real message isn’t lost. Chronic pain patients need to be believed so that they can receive the best evidence-based pain management possible.

 Photo by lel4nd via Flickr. 

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  9. Dr. Craig A. Maxwell   May 15, 2014 at 1:33 pm

    Thank you for this insightful article, Dr. Chambers. It’s unfortunate that there is such a stigma that goes along with chronic pain. I have had patients confide in me that even as children they were told they were “making it up for attention”. Children and young adults struggle with chronic pain as well. It’s important that anyone living with a chronic condition be treated with respect and understanding. It goes a long way in improving likelihood of recovery.

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