Factors Affecting Hospital Staff Judgments About Sickle Cell Disease Pain
- 386 Downloads
Judgments about people with pain are influenced by contextual factors that can lead to stigmatization of patients who present in certain ways. Misplaced staff perceptions of addiction may contribute to this, because certain pain behaviors superficially resemble symptoms of analgesic addiction. We used a vignette study to examine hospital staff judgments about patients with genuine symptoms of analgesic addiction and those with pain behaviors that merely resemble those symptoms. Nurses and doctors at hospitals in London, UK, judged the level of pain, the likelihood of addiction, and the analgesic needs of fictitious sickle cell disease patients. The patient descriptions included systematic variations to test the effects of genuine addiction, pain behaviors resembling addiction, and disputes with staff, which all significantly increased estimates of addiction likelihood and significantly decreased estimates of analgesic needs. Participants differentiated genuine addiction from pain behaviors resembling addiction when making judgments about addiction likelihood but not when making judgments about analgesic needs. The treatment by staff of certain pain behaviors as symptoms of analgesic addiction is therefore a likely contributory cause of inadequate or problematic hospital pain management. The findings also show what a complex task it is for hospital staff to make sensitive judgments that incorporate multiple aspects of patients and their pain. There are implications for staff training, patient education, and further research.
KEY WORDS:vignette study pain judgments addiction pseudoaddiction analgesics sickle cell disease.
Many thanks to the staff at Barts and the Royal London Hospital, Homerton University Hospital, and Newham University Hospital who took part in the study or helped to facilitate the data collection, especially Bernice Burton, John Coakley, Bunia Gorelick, Mahendra Kuruppurachch, Peter Loader, Joanne Morris, Rachel Simon, and Paul Telfer. Thanks also to Liz Robinson for the suggestion that led to the study, to David Hardman, Robin Iwanek, and Nick Troop for advice about the statistical analysis, and to the referees for their helpful comments on a previous draft.
- American Psychiatric Association (2000). DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorder, 4th ed., Washington DC: American Psychiatric Association.Google Scholar
- Elander, J., Lusher, J., Bevan, D., Telfer, P., and Burton, B. (2004). Understanding the causes of problematic pain management in sickle cell disease: Evidence that pseudoaddiction plays a more important role than genuine analgesic dependence. J. Pain Symptom. Manage. 27: 156–169.PubMedCrossRefGoogle Scholar
- Green, C. R., Anderson, K. O., Baker, T. A., Campbell, L. C., Decker, S., Fillingim, R. B., Kaloukalani, D. A., Lasch, K. E., Myers, C., Tait, R. C., Todd, K. H., and Vallerand, A. H. (2003). The unequal burden of pain: Confronting racial and ethnic disparities in pain. Pain Med. 4: 277–294.CrossRefPubMedGoogle Scholar
- Harden, R. N., Weinland, S. R., Remble, T. A., Houle, T. T., Colio, S., Steedman, S., and Kee, W. G. (2005). Medication quantification scale version III: Update in medication classes and revised detriment weights by survey of American Pain Society physicians. J. Pain 6: 364–371.PubMedCrossRefGoogle Scholar
- Lundquist, L. M., Higgins, N. C., and Prkachin, K. M. (2002). Accurate pain detection is not enough: Contextual and attributional style as biasing factors in patient evaluations and treatment choice. J. Appl. Biobehav. Res. 7: 114–132.Google Scholar
- Lusher, J., Elander, J., Bevan, D., Telfer, P., and Burton, B. (in press). Analgesic addiction and pseudoaddiction in painful chronic illness. Clinical Journal of Pain.Google Scholar
- Shelley, B., Kramer, K. D., and Nash, K. B. (1994). Sickle cell mutual assistance groups and the health care delivery system. In Nash, K. B. (Ed.), Psychosocial Aspects of Sickle Cell Disease: Past Present and Future Directions of Research, New York: Haworth Press, pp. 243–259.Google Scholar