Poster No:
812
Submission Type:
Abstract Submission
Authors:
ELIZABETH LOSIN1, Nikta Khalilkhani2, Theoni Varoudaki3, Morgan Gianola4
Institutions:
1The Pennsylvania State University, State College, PA, 2Penn State University, State College, PA, 3Penn State Univeristy, State College, PA, 4University of Miami, Coral Gables, FL
First Author:
Co-Author(s):
Introduction:
Unequal prescribing of opioid and non-opioid analgesics among demographic groups contributes to two major health disparities in the United States. Overprescribing of opioid analgesics to treat both acute and chronic nonmalignant pain, especially in non-Hispanic whites, has fueled an epidemic of opioid abuse. Underprescribing of opioid and non-opioid analgesics in minorities and women reduces the effectiveness of pain management in these groups. Existing literature suggests one possible mechanisms underlying analgesic prescribing disparities is that clinicians may experience less shared pain as indexed by reduced activation of pain-related neural systems (e.g. anterior cingulate, anterior insula), when observing the pain of demographic outgroup vs ingroup patients resulting in reduced analgesic prescription to these patients (i.e., the vicarious pain hypothesis). Ultimately, understanding the sociocultural, psychological, and neurobiological mechanisms underlying these disparities may help us train clinicians in ways that reduce them.
Methods:
In order to test possible mechanisms underlying pain assessment and treatment disparities we had N=67 (34 f) medical students complete a virtual pain management task while undergoing fMRI. Each clinician saw a diverse group of 36 mock patients with acute musculoskeletal pain from a recent injury. During each simulated pain management appointment clinicians 1) saw a medical vignette with patient information, 2) saw a video depicting the patient in pain meant to simulate the clinical examination, and 3) rated how much pain they thought the patient was experiencing and how likely they would be to prescribe an analgesic. In order to test for the best predictors of clinician's accuracy in their assessment of patients' pain (defined as the difference between the clinician and patients' pain intensity rating) and in their assessment of the patient's need for treatment (defined as the difference between the clinicians' likelihood of prescribing an analgesic and the patients' ratings of their pain unpleasantness) we performed an exploratory analysis using Stochastic Search Variable Selection.
In this analysis, brain predictors included average brain activity of clinicians when reading patient medical vignettes and observing their pain expressions in two a priori regions of interest related to pain empathy from a previous meta-analysis as well as a mask of regions associated with empathy from an automated meta-analysis using Neurosynth. We also included a suite of other predictors related to both the clinician (e.g. clinician's year of medical training, and clinician's responses to an empathy questionnaire) and the mock patient (e.g. the intensity of the patient's pain facial expression).
Results:
We found that the clinician's reported level of trait empathic concern and brain activity within the Neurosynth empathy mask when observing patients in pain positively predicted the accuracy with which the clinician assessed the patients pain. We also found that the clinician's reported level of trait empathic concern and perspective taking and the clinician's perception of the patient's higher attractiveness and higher socioeconomic status positively predicted the accuracy of their assessment of the patient's need for treatment.
Conclusions:
Our findings are consistent with the vicarious pain hypothesis and suggest that the degree to which clinicians empathize with and vicariously share the pain of their patients (as indexed by pain-related brain activation) increases a clinician's ability to accurately assess their patient's pain. Given that a wealth of literature in social neuroscience demonstrates that people display a reduction in brain markers of pain empathy for targets they perceive to be outgroup members, all of these findings are plausible mechanisms of widespread pain assessment and treatment disparities.
Emotion, Motivation and Social Neuroscience:
Social Cognition 1
Modeling and Analysis Methods:
Multivariate Approaches
Perception, Attention and Motor Behavior:
Perception: Pain and Visceral 2
Keywords:
ADULTS
Multivariate
Pain
Social Interactions
1|2Indicates the priority used for review
Provide references using author date format
None