People believe they report their pain accurately while holding the paradoxical belief that others exaggerate it. A study published in The Journal of Pain refers to this phenomenon as the fundamental pain bias.
There is a prevalent belief that people exaggerate their pain. This has implications in healthcare, such as healthcare providers underestimating or disagreeing with patient reports. This belief may be further enhanced when there are concerns about malingering and drug-seeking. Women and racialized individuals receive a disproportionate amount of skepticism, which has implications for their pain treatment.
In this work, Brandon L. Boring and colleagues examine two research questions. First, do people over-report their pain? Second, what are people’s thoughts on how others report pain?
Study 1 recruited 92 undergraduate participants who completed questionnaires assessing normative pain reporting behavior. This included questions such as “When you go to the doctor’s office and are asked to report how much pain you are feeling, what do you normally do?” with three options corresponding to selecting a number lower than their experienced pain, actual pain, or greater pain.
Using these options, they also responded to questions assessing what they believed a person normally reports when asked to rate their pain. Next, participants read four hypothetical vignettes for which they were instructed to imagine themselves reporting their pain to a doctor or dentist in an outpatient or surgical setting, using the same response options.
A fifth vignette providing a more detailed description of the participant visiting a doctor for abdominal pain was also presented. Participants were told to imagine their pain was at a 5 (moderate), and were then asked how they would actually report it. They concluded the study by providing demographic information.
Boring and colleagues found that people were unlikely to over-report their pain, challenging the widespread belief that pain reports are exaggerated. In fact, people were more likely to under-report their pain in clinical settings. Surgical contexts encouraged modulation of pain reports in the direction of over-reporting.
Further, people endorsed the belief that others provide higher ratings of pain compared to themselves. In exploring demographic differences, the researchers found that women and Latin American participants had a greater likelihood of under- (vs. over-) reporting their pain.
Study 2 recruited 248 residents of the United States on TurkPrime. A minimum quota of 100 individuals was specified for Latin Americans, as the purpose of Study 2 was to provide a more statistically powered replication of Study 1, while recruiting a more representative sample.
The researchers once again found that participants reported their pain as-is in clinical settings, while endorsing that others over-report it. Modulation was context-dependent, with over-reporting being more likely in surgical (but not outpatient) settings. Men had a greater likelihood of over- (vs. under-) reporting pain to dentists. There were no overall differences between men and women in pain reporting.
Further, Latin and White Americans were equally likely to report their pain as-is to a doctor and dentist. However, Latin Americans were more likely to over-report their pain in surgical contexts. Lastly, men (vs. women) were more likely to hold the belief that others exaggerate their pain.
Differences in findings between the two studies may be explained by the more representative and larger sample, as well as older mean age, in Study 2.
The authors note, “assessing the pain reporting behaviors and beliefs among groups not represented in this sample but that also face systemic discrimination is vital for clarifying reporting and countering mechanisms that contribute to pain disparities.”
The research, “Over-Rating Pain is Overrated: A Fundamental Self-Other Bias in Pain Reporting Behavior”, was authored by Brandon L. Boring, Brandon W. Ng, Namrata Nanavaty, and Vani A. Mathur.
