Research: LANG and colleagues,

Listed in Issue 129

Abstract

LANG and colleagues, Department of Radiology, Beth Israel Deaconess Medical Center, 02215 Boston, MA, USA, have found that words can hurt.

Background

Patients are often prepared for procedural discomforts with descriptions of pain or undesirable experiences. This practice is thought to be compassionate and helpful, but there is little data on the effect of such communicative behaviour. The aim of this study was to assess how such descriptions affect patients’ pain and anxiety during medical procedures.

Methodology

The interactions of patients with their healthcare providers during interventional radiological procedures were videotaped during a previously reported 3-arm prospective randomized trial assessing the efficacy of self-hypnotic relaxation. 159 videos of the standard care and attention control arms were reviewed. All statements that described painful or undesirable experiences as warning before potentially noxious stimuli or as expression of sympathy afterwards were recorded. Patients’ ratings of pain and anxiety after the painful event and/or sympathizing statement were the basis for this study.

Results

Warning the patient in terms of pain or undesirable experiences resulted in greater pain (p<0.05) and greater anxiety (p<0.001) than not doing so. Sympathizing with the patient in such terms after a painful event did not increase reported pain, but resulted in greater anxiety (p<0.05).

Conclusion

Conclusions: Contrary to common belief, warning or sympathizing using language that refers to negative experiences may not make patients feel better. This conclusion has implications for the training in medical communication skills and suggests the need for randomized trials testing different communications.

References

Lang EV, Hatsiopoulou O, Koch T, Berbaum K, Lutgendorf S, Kettenmann E, Logan H, Kaptchuk TJ.  Can words hurt? Patient-provider interactions during invasive procedures. Pain 114 (1-2): 303-309, Mar 2005.

Comment

A most interesting and counter-intuitive study! Perhaps the old ‘look away and forget about it’ works with certain patients.

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