The Effect of Discussing Pain on Patient-Physician Communication in a Low-Income, Black, Primary Care Patient Population

A new study using direct observation of video-recorded physician visits helps understand the aspects of patient-physician communication.

The Issue:

Communication between patients and physicians relating to pain have been reported as being frustrating and unproductive. In this study, patients completed questionnaires about demographics and severity of bodily pain over the past four weeks. Analyzing 133 video-recorded visits—a “thin slice” method was used to rate two or three 30-second video segments from each visit. Variables used in the factor analysis included patient unease and patient positive engagement, as well as physician unease and physician positive engagement. The nonverbal communication displayed in the video segments was studied by observing the variation in levels of rapport and affect.


Key Findings:

  • Patient discussions about pain were associated with significantly greater patient unease compared with discussions about other topics. Discussions about pain also resulted in an increase in patient affect, i.e., displayed emotion.
  • Patient pain severity was significantly associated with greater physician and patient unease.



This study mentions some notable limitations. However, the results indicate that pain discussion is an emotionally-charged topic in primary care which physicians should be cognizant of.


About the Study:

Over 98 percent of the patients reported their ethnicity as Black. Physician participants included 17 family medicine residents.

“Strong social and institutional conventions” may keep relational aspects of patient-physician communication from changing as much as individual communication behaviors, the authors say. Read more