Health Professionals Underestimate Prolonged Acute Pain and Analgesic Requirements From Facial Expressions: Contributions of Empathy, Compassion Fatigue and Work Experience

BACKGROUND AND AIMS: Estimating patients' pain intensity is central to health professionals' (HP) practice. Experimental studies using facial expressions as cues indicate that HP underestimate pain compared to patients' self-assessment and non-HP individuals. Since most studies involved stimuli in a context of brief, experimentally induced pain, we examined whether such underestimation also occurs for facial expressions of patients experiencing naturally occurring prolonged acute pain. We also investigated the relationships between pain and analgesic level estimations in HP and explored the relationships between empathic tendencies, professional quality of life, work experience and pain estimation. METHODS: Sixty-three HP (mostly nurses) and 60 non-HP controls completed a computerized task assessing pain intensity and analgesic level estimations from postoperative patients' facial expressions. Empathic tendencies were assessed in both groups while HP also completed a professional quality of life questionnaire. We conducted mixed models, bivariate correlations and exploratory path analyses. RESULTS: HP underestimated moderate to severe pain compared to patients and non-HP controls and estimated lower analgesic levels. In HP, pain estimation was positively associated with personal distress tendencies, which were in turn related to higher secondary traumatic stress, a component of compassion fatigue. Perspective-taking tendencies were negatively associated with pain estimation and were lower among more experienced HP compared to less experienced HP. Pain estimation was strongly associated with analgesic level estimation. CONCLUSION: These findings highlight the psychological complexity underlying the estimation of prolonged acute pain and raise the hypothesis that maladaptive regulation of self-oriented distress may contribute to pain and analgesic underestimation in HP. This hypothesis warrants investigation in future research. RELEVANCE TO CLINICAL PRACTICE: HP misestimate patients' prolonged acute pain when relying solely on facial expressions, and this is associated with lower analgesic level estimations. Interrelationships between pain estimation, empathic tendencies, and professional quality of life raise the possibility that pain underestimation may relate to maladaptive emotion regulation, which underlines the relevance of emotional factors to clinical pain assessment. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. REPORTING METHOD: This study was reported in accordance with recommended quantitative reporting standards. TRIAL REGISTRATION: NCT03957967 at clinicaltrials.gov.