AUGUST 13, 2024
Data from a study indicate that physician empathy is more strongly associated with the outcomes of patients with chronic low back pain (LBP) than nonpharmacologic treatments, opioid therapy or lumbar spine surgery (JAMA Netw Open 2024;7[4]:e246026).
What’s more, study participants treated by very empathic physicians (VEPs) reported having significantly better outcomes pertaining to pain, function and health-related quality of life (HRQOL) compared with patients treated by only slightly
Data from a study indicate that physician empathy is more strongly associated with the outcomes of patients with chronic low back pain (LBP) than nonpharmacologic treatments, opioid therapy or lumbar spine surgery (JAMA Netw Open 2024;7[4]:e246026).
What’s more, study participants treated by very empathic physicians (VEPs) reported having significantly better outcomes pertaining to pain, function and health-related quality of life (HRQOL) compared with patients treated by only slightly empathic physicians (SEPs).
“Physician empathy is an important aspect of the patient-physician relationship among those with chronic pain. Greater efforts to cultivate and improve physician empathy appear warranted in this population,” the study authors concluded.
The cohort study included 1,470 adults with chronic LBP (mean age, 53.1 years; 74.4% female) who reported on the empathy of their providers using the CARE (Consultation and Relational Empathy) Measure. Patients completed 5,943 encounters with physicians between April 1, 2016, and July 25, 2023. Patient data were collected longitudinally with a maximum of 12 months of follow-up.
Participants who were treated by a VEP compared with those treated by an SEP reported statistically significant lower mean pain intensity (6.3 vs. 6.7 on a numerical rating scale from 0-10) and less mean back-related disability (14.9 vs. 16.8 on the Roland-Morris Disability Questionnaire, which ranges from 0-24). Patients treated by a VEP reported fewer HRQOL deficits using the Patient-Reported Outcomes Measurement Information System. This involved measures of anxiety, depression, fatigue, sleep disturbance and pain interference. The scores for each category between the VEP and SEP groups were 54.6 versus 57.5, 53 versus 56.1, 58 versus 61.6, 56.6 versus 59.1 and 61.9 versus 65.6, respectively. All VEP compared with SEP group differences were clinically relevant and statistically significant.
Multivariable analyses demonstrated that greater physician empathy was inversely associated with pain intensity (beta=–0.014; P<0.001), back-related disability (beta=–0.062; P<0.001) and all HRQOL measures.
Researchers controlled for the following factors to account for potential confounders: age, sex, race, ethnicity, educational level, cigarette smoking status, musculoskeletal comorbidities (herniated disc, sciatica, osteoarthritis and osteoporosis), general medical comorbidities (hypertension, heart disease, diabetes, asthma and depression), chronic LBP treatments including nonpharmacologic treatments (exercise therapy, yoga, massage therapy, spinal manipulation, acupuncture and cognitive behavioral therapy) and opioid therapy, and lumbar spine surgery.
The researchers believe that their sensitivity analysis suggests “the greatest improvements in pain-related outcomes may be achieved by targeting for intervention those physicians comprising the lowest decile of empathy,” but acknowledge that teaching empathy may not be possible. Even if it is possible, “empathy should not be limited to individual practitioners but should be incorporated within the broader domain of healthcare systems.”
Thomas L. Schwenk,, MD, a dean emeritus from the University of Nevada, Reno School of Medicine, who was not associated with the study, also noted that “the nature of caring for patients with chronic low back pain—or any chronic pain—certainly involves the need for compassion, shared decision making, negotiation of goals and treatment plans, and other aspects of a caring relationship for which higher empathy might be helpful. Physicians with higher empathy might be more willing to explore alternative approaches to pain management.”
However, Schwenk shared the authors’ concern that there is no proof that empathy can be taught. This led him to conclude that “there isn’t a real clinical takeaway at this point because this was not an intervention study. Observational association studies, even when well controlled, cannot directly speak to causality. But the results are intriguing and suggest that higher-empathy physicians may have better clinical outcomes for chronic low back pain patients.”
—Myles Starr
Schwenk reported no relevant financial disclosures.
