Physician empathy tied to favorable health outcomes among those with chronic low back pain
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Key takeaways:
- Based on the results, researchers encouraged physicians to be more empathetic during chronic pain encounters.
- However, there is a debate on whether physician empathy can be taught.
Physician empathy was inversely associated with several health outcomes among adults with chronic low back pain, such as pain intensity and back-related disability, a study demonstrated.
According to John C. Licciardone, DO, MS, MBA, FACPM, a Regents Professor of family medicine and osteopathic manipulative medicine at the University of North Texas Health Science Center at Forth Worth, and colleagues, the patient-physician relationship is “fundamental to the practice of medicine,” and physician empathy “may enhance patient adherence to treatment and improve clinical outcomes.”
The patient-physician relationship is particularly important for patients with chronic low back pain “because patients often feel isolated, misunderstood, or stigmatized when an underlying cause of pain cannot be identified,” Licciardone and colleagues wrote in JAMA Network Open.
The researchers evaluated the impact of physician empathy among a cohort of 1,470 adults (mean age, 53 years; 74.4% women) with chronic low back pain from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation national pain research registry.
The study’s main outcomes were patient-reported pain intensity, back-related disability and health-related quality of life (HRQOL) deficits in measures like fatigue, depression and pain interference.
Overall, greater physician empathy — which was assessed with the Consultation and Relational Empathy measure — at 12 months of follow-up was inversely associated with:
- pain intensity (beta = 0.014; 95% CI, 0.022 to 0.006);
- back-related disability (beta = 0.062; 95% CI, 0.085 to 0.04); and
- HRQOL deficit measures, like pain interference (beta = 0.08; 95% CI, 0.111 to 0.049).
The researchers also found that, compared with patients treated by slightly empathic physicians, those treated by very empathic physicians had:
- lower mean pain intensity scores (6.7 vs. 6.3);
- lower mean back-related disability scores (16.8 vs. 14.9); and
- lower scores on each HRQOL deficit measure, like fatigue (60.4 vs. 57.3).
Physician empathy was further associated with more favorable outcomes compared with opioid therapy, nonpharmacological outcomes and lumbar spine surgery, according to the researchers.
The results suggest that empathy should be encouraged for chronic pain, but “there is a longstanding debate about whether it can or should be taught,” Licciardone and colleagues noted.
“One view is that physician empathy cannot be achieved in the patient-physician relationship and questions attempts to measure it,” they wrote. “An alternative view is that it is a skill that, although partly genetic, can be purposefully grown, broadened, and fine-tuned through life experiences to improve medical care.”
There were several study limitations, according to the researchers. For example, factors like physician demographics, specialty and clinical settings were not measured and participants who could not complete case report forms in English were excluded.
Ultimately, “greater efforts to cultivate and improve physician empathy appear warranted in this population,” the researchers wrote, while further research “involving rigorous designs is needed to determine if greater physician empathy improves clinical outcomes.”
Perspective
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This study highlights critical insights into the profound impact of physician empathy on the management and outcomes of chronic pain, particularly chronic low back pain, one of the most common and vexing patient presentations we see every day in the clinic. Given the study's findings that physician empathy yields more favorable outcomes than nonpharmacological treatments, opioid therapy and even lumbar spine surgery, it positions empathy not just as beneficial but potentially as a cornerstone of effective chronic pain management.
These findings really highlight what we already know: that chronic pain is a highly subjective disease process and emphasizes that empathy is not just a soft skill but a critical component of effective medical care. Patients who feel like they are being taken care of will make more progress in their treatment.
These insights could transform patient interactions, especially for those with chronic pain conditions where traditional treatment modalities often fall short. Although these patients can be some of the most difficult and prickly patients to treat, it reminds how we all originally got into this field to help patients and because we care about other people. This can be one of the most powerful tools we have at our disposal. If patients feel supported, it’s amazing how many begin to heal themselves.
For me, the study encourages a reflective examination of my practice and the role of empathy in patient care. It supports targeted efforts to cultivate empathy within medical education and ongoing professional development.
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