Pain Treatment Decision-Making
We are interested in how patient, provider, and contextual factors influence pain assessment and treatment decisions. In this work, we often use computer-simulated patients and environments, which allow us to manipulate and test hypotheses about key characteristics that influence the clinical encounter. Complementing our computer-simulations, we also use full-motion videos of real patients with pain engaging in functional tasks (e.g., getting out of bed, picking up items off the floor). Both approaches allow us to better understand potential mechanisms that underlie disparities in pain care and use this knowledge to develop targeted interventions that improve providers’ pain treatment decisions and patients’ self-management.
Currently, we are using our computer-simulated patients in a 5-year randomized controlled trial of a provider-focused perspective-taking intervention to reduce racial and socioeconomic disparities in pain care. This intervention provides personalized feedback to physicians about their biases and the opportunity to interact with computer-simulated patients tailored to physicians’ unique biases and watch videos depicting how pain has impacted the patients’ lives. The intervention is designed to increase physicians’ awareness of their biases, enhance their empathy toward patients, and reduce their anxiety/threat toward patients. We hypothesize that these changes will be the primary mechanisms underlying reductions in pain treatment disparities for physicians in the intervention group.
Computer-simulated patients depicting a Black patient of high socioeconomic status (left) and a White patient of low socioeconomic status (right)
We also examine pain treatment decision-making from the patient's perspective. For example, we have worked with patients at the Indiana Polyclinic—a local comprehensive pain treatment center—to better understand how and why patients decide to seek pain-related disability compensation. We are particularly interested in the social aspects of these decisions, given that patients with pain often consult with peers for information and advice (e.g., online forums).
We are interested in how psychological factors (e.g., pain-related injustice, coping, and resilience) and social factors (e.g., caregivers’ catastrophizing and injustice perceptions) influence pain and functioning in children/adolescents with pain. We have an ongoing collaboration with the Pain Clinic at Riley Children’s Hospital to use longitudinal clinical data to examine the influence of pain-related injustice and catastrophizing (measured in both children and caregivers) on pain and functioning in children/adolescents with pain.
We have also recently created computer-simulated children and caregivers to use in research examining psychosocial factors that facilitate and impede the delivery of guideline-concordant care for children/adolescents with pain. For example, in a current study using these computer-simulated pediatric patients, we are examining (1) how providers’ pain assessment and treatment decisions vary by child race and gender, (2) the extent to which providers’ racial and/or gender biases (implicit and explicit) influence their pain decisions, and (3) the relationship between providers’ gaze patterns (measured with eye-tracking technology) and their pain decisions.
Pediatric patient and caregiver stimuli. Each color represents a participant's eye-tracking. Circle size indicates how long the participant looked at certain parts of the stimuli.
Quantitative Sensory Testing
In our laboratory-based research, we use quantitative sensory testing—a group of procedures that assess perceptual responses to systematically applied and quantifiable sensory stimuli in order to characterize somatosensory function—on healthy laypersons to examine the interaction of biological, psychological, and social factors related to pain.
For example, we have conducted a series of studies examining how differences in pain-related coping (e.g., use of prayer) contribute to race differences in pain sensitivity during a cold pressor task. In a separate series of studies, we are examining the extent to which participants’ beliefs (implicit and explicit) about race differences in pain sensitivity are related to actual race differences in pain sensitivity.
Cold pressor task