Emotions and pain: The role of empathy
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For readers of my column over the past decade, many will recognize that on numerous occasions I have chosen to discuss empathy.
I became interested in this topic nearly 20 years ago when I was charged to develop a course on medical humanism in our new medical school. Until then, although the notion of empathy was of interest to me, I had not yet given the science of empathy any formal thought. To learn more, I reached out to Mohammadreza Hojat, PhD, the prime architect of the Jefferson Empathy Scale, the most widely used metric to measure empathy in health care, and began a journey of inquiry and research. This journey into empathy in medicine has influenced my own personal reflective and clinical practice in so many positive ways.
!["[Empathy] is a powerful tool that can bring comfort and relief to our patients in the course of minor to catastrophic life experiences," stated Leonard H. Calabrese, DO.](/~/media/images/news/print/healio-rheumatology/2024/05_may/adobestock_781394689_1200x630_og.jpg?w=800)
Image: Adobe Stock
This month’s cover story exclusive, featuring Desiree Azizoddin, PsyD, Daniel Clauw, MD, Beth Darnall, PhD, Philip J. Mease, MD, and Pavan Tankha, DO, as our discussants, has again given me an opportunity to reflect on the power of empathy. I would like to share with you briefly why I feel stronger than ever that the healing arts desperately need not only to keep the pilot light of empathy alive, but also nurse, grow and strategically incorporate it into the art and science of healing.
The cover story centers around the plight of patients with chronic pain and the capacity for psychic factors — including emotional pain, past trauma and mood disorders — to amplify pain and possibly even exacerbate or trigger autoimmune disorders. This is an area of investigation whose time is now and, while still a work in progress and surrounded by uncertainty and controversy, is moving ahead rapidly. From my perspective, I believe that regardless of the weight of evidence supporting the role for neuropsychologic and neurophysiologic factors to modify pain and immune function, I believe it is increasingly clear that modifying central neurophysiologic pathways through drugs and — more importantly — behavior can go far in ameliorating chronic pain and suffering.
Furthermore, I believe we practitioners have a tool available to us daily, which we can use to intervene and potentially improve the quality of life of our patients with not only chronic pain but also fatigue (but that is a separate subject so please stay tuned).
Empathy from 30,000 feet is a fuzzy area that encompasses the ways we react and process others’ emotional states. Empathy is something we develop or cultivate — positively or negatively — from our genes and, more importantly, our upbringing and early life experiences. In my opinion, it is a trait and skill we develop or lose along our path in life.
For we health care practitioners, it is also a powerful tool that can bring comfort and relief to our patients in the course of minor to catastrophic life experiences. Importantly as healers, employing empathy in our practice requires our capacity to communicate it to our patients, and that is where it becomes a teachable skill. For those interested in a moving and elegant brief discussion of the complexities of empathy in health care, I suggest a brilliant perspective piece by Jamil Zaki, PhD, “The caregiver’s dilemma: In search of sustainable medical empathy.”
In agreement with our discussants, I believe there is no doubt that in medicine, words matter to patients, especially those with chief complaints of chronic pain and fatigue. I will also note that when applying empathy in clinical practice, much — if not most — of our power lies in our nonverbal interactions with our patients, including how we use our body language, our eye contact and, when appropriate, our respectful and gentle touch.
In support of the healing powers of empathy, I cite a recent important paper in JAMA by Licciardone and colleagues exploring the relationship between physician empathy — as reflected through the eye of the patient — and important clinical outcomes in those with chronic back pain. The paper demonstrated that physician empathy was associated with better clinical outcomes over 12 months. This important study is yet another, and elegant, investigation supporting the importance of the patient-physician relationship — or as many in the placebo world refer to as the “healing relationship” — in achieving better outcomes in patients with chronic pain.
As Dr. Azizoddin notes in our cover story, words, such as merely telling them that their pain “is real and not their fault,” can have power in patients who are chronically suffering. I believe it is again time to revisit the field of empathy science in health care and, in particular, the field of rheumatology. As the debate continues regarding the question of whether empathy can be taught, I believe that there is no doubt that the communication of empathy to patients is a teachable skill. That’s my take. What’s yours? Please share your thoughts with me at calabrl@ccf.org or at rheumatology@healio.com.
- References:
- Licciardone JC, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.6026.
- Zaki J. Lancet. 2020;doi:10.1016/S0140-6736(20)31685-8.
- For more information:
- Leonard H. Calabrese, DO, is the Chief Medical Editor, Healio Rheumatology, and Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic.
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