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According to a new study, higher patient-reported ratings of physician empathy were associated with improved outcomes in patients with chronic lower back pain.¹

Increasing physician empathy and positive messaging seems to benefit pain outcomes for various conditions.² One study demonstrated that a positive physician-patient relationship was associated with better clinical outcomes after 8 weeks of treatment for patients with chronic lower back pain.³ Additionally, another study showed that physician empathy was associated with improved pain outcomes and health-related quality of life at 3 months.⁴ However, long-term studies are lacking. 

In this new study, investigators assessed the relationship between physician empathy and patient outcomes over 12 months.¹ 鈥淲e conducted the study to learn more about how the patient-physician relationship impacts the outcomes of patients living with chronic pain, including their health-related quality of life,鈥� said lead author John Licciardone, DO, of the University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas, in an interview with 乌鸦传媒視頻.

The report was published in JAMA Network Open. 

Study design and participants

For this study, data were obtained from patients enrolled in the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION), a registry of individuals with chronic lower back pain.⁵ The PRECISION registry collects reports from participants using various self-report measures but does not collect data on income or health insurance or information about the physician. Participants in the registry were unaware of the specific research topic.

The inclusion criteria were age 21 to 79, chronic lower back pain for 鈮�3 months, being under the care of a physician for back pain, and the ability to complete forms in English.¹ 

Data were self-reported at enrollment and at quarterly visits over 12 months. At enrollment, participants reported physician empathy by the Consultation and Relational Empathy (CARE) measure, which has 10 items for patients to rate with scores of 1 for poor through 5 for excellent.⁶ The total CARE measure was the sum of the 10 scores, with 30 or higher classified as very empathic and 29 or lower as slightly empathic.¹

The primary outcomes were pain rated 0 to 10 over the previous 7 days, function as assessed by the Roland-Morris Disability Questionnaire, and health-related quality of life on the Patient-Reported Outcomes Measurement Information System, which has 29 items.¹

Participant characteristics and physician empathy ratings

The investigators identified 1470 participants. Of these, 1093 (74.4%) were female, and the mean age of all participants was 53.1 卤 13.2 years.¹

The mean CARE measure scores were 38.4 卤 11.6 overall at enrollment. At a 24-month follow-up with 319 participants, the mean CARE measure scores did not significantly change from enrollment. And no significant difference was found in CARE measure scores at enrollment between participants who were versus were not lost to follow-up.¹

At enrollment, 1133 (77.1%) rated their physician as very empathic, and 337 (22.9%) rated their physician as slightly empathic. The mean CARE measure scores at enrollment were 43.7 卤 6.6 for the very empathic physician group and 20.6 卤 5.9 for the slightly empathic physician group (P<.001).¹

Participants in the slightly empathic physician group reported higher frequencies of current smoking (P=.02), herniated disc (P=.02), and depression (P=.03) compared with those in the very empathic physician group.¹

Outcome differences

After adjusting for potential confounding covariates, such as demographic characteristics, comorbidities, duration of back pain, and treatments, participants in the very empathic physician group reported better ratings for pain and function over 12 months compared with those in the slightly empathic physician group. The mean pain intensity over 12 months was 6.3 (95% CI, 6.1-6.5) in the very empathic physician group compared with 6.7 (95% CI, 6.5-6.9) in the slightly empathic physician group (P<.001).¹

Other outcomes were also rated less severe in the very empathic physician group. The mean back-related disability was 14.9 (95% CI, 14.2-15.6) in the very empathic physician group compared with 16.8 (95% CI, 16.0-17.6) in the slightly empathic physician group (P<.001).¹

Similarly, after adjustment for covariates, health-related quality of life deficits were lower in participants with very empathic physicians, including anxiety, depression, fatigue, sleep disturbance, and pain interference (P<.001 for each). For example, the mean score for fatigue was 57.3 (95% CI, 56.1-58.5) in the very empathic physician group compared with 60.4 (95% CI, 59.0-61.7) in the slightly empathic physician group (P<.001).¹

Clinical relevance

The investigators judged these differences to be clinically relevant. They noted that the values for 尾 coefficients for very empathic physicians compared with slightly empathic physicians were greater than those for treatments, including nonpharmacologic treatments, opioids, and lumbar spine surgery, among the study participants.¹

鈥淧hysicians should understand that their interaction with patients having chronic low back pain may have a profound influence on the course of their treatment and outcomes, potentially greater than the effects attributed to drug therapy or spinal surgery,鈥� Dr. Licciardone told 乌鸦传媒視頻.

The study's limitations include the inability to assess causality and the use of only self-reported data. The PRECISION registry also has limitations, as it is a volunteer registry and not population-based. It also lacks information about socioeconomic status, physician demographics, and clinical practice characteristics.¹

The investigators suggested that more research is needed to understand whether empathy can be increased among physicians and, if so, whether it would improve clinical outcomes.¹

They also noted that there is more to the patient-physician relationship than empathy. 鈥淲e are interested in conducting more research involving other aspects of the patient-physician relationship, including how physicians communicate with their patients and to what degree they engage in shared decision-making about chronic pain treatment options,鈥� said Dr. Licciardone.

Using the PRECISION registry, 鈥淸w]e plan to conduct more research using observational data on the patient-physician relationship in a natural setting to answer questions that cannot be addressed by clinical trials involving artificially manipulated physician interactions.鈥�

Published: June 28, 2024