The importance of patient expectations

Patients’ beliefs and expectations need to be better understood by clinicians to improve management. Asking the question, What is your understanding of your pain? Do you believe that it is just a physical / mechanical problem?

Spending the time to really hear your patient’s story and understand what they expect from this treatment regarding their pain and recovery is fundamental.

Patient’s who hold a very strong biomedical view of their pain are likely to have poorer outcomes with treatment.

Dunn et al. (2013) found that patient who held poor expectations regarding the role of rehabilitation were the strongest predictor of surgery.

Patient’s who have low expectations regarding the effectiveness of physical therapy are more likely to fail non-operative treatment. And patient’s who have more of a biomedical understanding of their pain have an increased perception that they will need a more serious intervention (Cuff & Littlewood. 2018)

Furthermore a pessimistic life attitude has been linked with increased pain sensitivity and increased likelihood of development of chronic pain, and general positive psychological attitudes such as dispositional optimism have been linked to lower pain intensity and better coping with pain (Dimova. 2015)

Firstly we need to explore our patients, beliefs, expectation, overall well being and the influence of their current pain experience on their life.

▶️ What does this diagnosis mean to you?
▶️ What is your understanding of this pain?
▶️ What do you think is causing the pain?
▶️ How do you cope with your pain?
▶️ How does it make you feel?
▶️ What do you believe is the worst that can happen?
▶️ What influence is this having on your life
▶️ How do you see the future?
▶️ What are you hoping to get out of this session

O’Sullivan. P et al. (2018)

Then ask yourself is this optimistic or pessimistic?

Believe it or not “Most of the pain we treat is not tissue based pain and the association between pain and tissue damage becomes weaker as pain persists” (Shala 2022)

Pain can be reduced by positive mood and emotional state AND pain can be increased by negative emotions and low mood (Villemure & Bushnell. 2002; Bushnell et al. 2013)

Addressing negative beliefs and considering all potential contributing factors to a patients pain experience is key to the successful management and further educating them how these various factors such as beliefs, emotions and cognition can influence their pain sensitivity.