Do our expectations have an impact on how well a treatment will alleviate pain? One of the key factors that will predict health outcomes is what we believe will happen prior to receiving the treatment. It is known in the literature that if we expect positive things, positive things are more likely to happen. Or in other words, when we believe a treatment will alleviate our pain, it tends to lead to better pain management.
Goal
Stéphanie Cormier and Alexandra Lévesque-Lacasse wanted to better understand what are some of the biological, psychological and social characteristics of people that are associated with their expectations of pain relief from a multidisciplinary pain treatment. This is important, as previous studies have highlighted the fact that asking people about their expected pain relief, was one of the strongest predictors of how well a treatment will actually succeed.
Methodology
The Quebec Pain Registry is an online database that comprises information about patients attending multidisciplinary pain clinics in the province of Quebec, Canada. This study used data from 3 110 participants treated between November 2008 and April 2012. Before their first visit to the pain clinic, participants completed a series of questionnaires about their expectations of pain relief as a result of the treatments offered at the clinic, and various biopsychosocial variables such as duration, intensity and location of their pain, physical health and pain interference, psychological health (depression, catastrophizing, anger, mental health) as well as sociodemographic characteristics (age, sex, ethnicity, civil status, education, work status, disability benefits status). Participants were categorized into four distinct groups: those with low, moderate, high and very high expectations regarding the level of pain relief they anticipated following the interventions they would receive at the pain clinic.
Main findings
Some of the characteristics of participants who held varying levels of expectations for pain relief were identified. Overall, lower expectations for pain relief were found in younger participants (older participants had higher expectations for pain relief), men (women had higher expectations for pain relief), and white participants (non-white participants had higher expectations for pain relief). Lower pain relief expectations were also found in participants with longer pain duration, poorer physical health and function, more severe symptoms of depression, and those receiving disability benefits. These differences in expectations might be due to the fact that some patients have tried numerous treatments with little or no success, which may have contributed to the lowering of their expectations for pain relief.
Take home message
Understanding which patients are more likely to have high or low expectations for pain relief, can help clinicians provide targeted interventions that can also help enhance patients’ expectations. Improving patients’ expectations is important as it can increase their likelihood of successfully responding to pain treatments. For instance, addressing psychological difficulties early on could enable patients to adopt a more engaging and positive outlook on upcoming interventions, which may potentially result in better pain management.
