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      Virtual human technology: patient demographics and healthcare training factors in pain observation and treatment recommendations

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          Abstract

          Background

          Patients’ sex, race, and age have been found to affect others’ perception of their pain. However, the influence of these characteristics on treatment recommendations from laypersons and healthcare providers is understudied.

          Design

          To address this issue, 75 undergraduates and 107 healthcare trainees (HTs) used a web-based delivery system to view video clips of virtual human (VH) patients presenting with different standardized levels of pain. Subjects then rated the VHs’ pain intensity and recommended the amount of medical treatment the VHs should receive.

          Results

          Results indicated that, compared with undergraduates, HTs perceived African Americans and older adults as having less pain but were more willing to recommend medical treatment for these patients than were undergraduate participants. HTs and undergraduates rated female, African American, older, and high-pain-expressing adults as having greater pain intensity than male, Caucasian, younger, and lower-pain-expressing adults. Moreover, they also recommended that female, older, and high-pain-expressing adults receive more medical treatment than male, younger, and lower-pain-expressing adults.

          Conclusions

          This study found that the characteristics of the VHs and whether the participants were undergraduates or HTs influenced the ratings of pain assessment and treatment recommendations. The findings are consistent with the previous VH literature showing that VH characteristics are important cues in the perception and treatment of pain. However, this is the first study to identify differences in pain-related decisions between individuals who are pursuing healthcare careers and those who are not. Finally, not only does this study serve as further evidence for the validity and potential of VH technology but also it confirms prior research that has shown that biases regarding patient sex, race, and age can affect pain assessment and treatment.

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          Most cited references 14

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          Pain and its treatment in outpatients with metastatic cancer.

          Pain is often inadequately treated in patients with cancer. A total of 1308 outpatients with metastatic cancer from 54 treatment locations affiliated with the Eastern Cooperative Oncology Group rated the severity of their pain during the preceding week, as well as the degree of pain-related functional impairment and the degree of relief provided by analgesic drugs. Their physicians attributed the pain to various factors, described its treatment, and estimated the impact of pain on the patients' ability to function. We assessed the adequacy of prescribed analgesic drugs using guidelines developed by the World Health Organization, studied the factors that influenced whether analgesia was adequate, and determined the effects of inadequate analgesia on the patients' perception of pain relief and functional status. Sixty-seven percent of the patients (871 of 1308) reported that they had had pain or had taken analgesic drugs daily during the week preceding the study, and 36 percent (475 of 1308) had pain severe enough to impair their ability to function. Forty-two percent of those with pain (250 of the 597 patients for whom we had complete information) were not given adequate analgesic therapy. Patients seen at centers that treated predominantly minorities were three times more likely than those treated elsewhere to have inadequate pain management. A discrepancy between patient and physician in judging the severity of the patient's pain was predictive of inadequate pain management (odds ratio, 2.3). Other factors that predicted inadequate pain management included pain that physicians did not attribute to cancer (odds ratio, 1.9), better performance status (odds ratio, 1.8), age of 70 years or older (odds ratio, 2.4), and female sex (odds ratio, 1.5). Patients with less adequate analgesia reported less pain relief and greater pain-related impairment of function. Despite published guidelines for pain management, many patients with cancer have considerable pain and receive inadequate analgesia.
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            Neural correlates of interindividual differences in the subjective experience of pain.

            Some individuals claim that they are very sensitive to pain, whereas others say that they tolerate pain well. Yet, it is difficult to determine whether such subjective reports reflect true interindividual experiential differences. Using psychophysical ratings to define pain sensitivity and functional magnetic resonance imaging to assess brain activity, we found that highly sensitive individuals exhibited more frequent and more robust pain-induced activation of the primary somatosensory cortex, anterior cingulate cortex, and prefrontal cortex than did insensitive individuals. By identifying objective neural correlates of subjective differences, these findings validate the utility of introspection and subjective reporting as a means of communicating a first-person experience.
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              • Abstract: found
              • Article: not found

              Gender bias in the observation of experimental pain.

              The aim of this study was to examine how men and women observe experimentally induced pain in male and female participants and to specifically determine the accuracy of observed pain ratings, the possible interactions between the sex of the viewer and the sex of the individual being observed, and the influence of gender role expectations on observed pain ratings. The sample comprised 29 participants (15 females). They each completed a battery of psychological questionnaires and viewed a presentation of 10 randomly ordered video clips. Each presentation consisted of 10 video clips, lasting 30s, of a participant (five males and five females) in the cold pressor task. The participants viewing the videos were asked to provide several ratings, including observed pain intensity and gender role related characteristics of the individual in the video. In terms of sex of the video participant, results indicated that viewers rated male videos as having less pain than female videos although the effect was small. Regarding sex of the viewer, results indicated that for both male and female videos, female viewers rated observed pain intensity significantly higher than did male viewers. In terms of accuracy, results indicated that on average, female video participants' pain was underestimated by 14 points, while male videos participants' pain was underestimated by 22 points (on a 0-100-point scale). Pain intensity ratings and pain tolerance from the participants in the videos did not differ significantly with respect to sex, though women had shorter tolerance times and higher pain ratings than men. Hierarchical regression analyses indicated that expectations of gender related 'endurance of pain' significantly predicted ratings of both male and female videos. When endurance expectations were controlled, sex of the viewer no longer significantly predicted observed pain ratings. The 'willingness to report pain' variable was not a significant predictor of observed pain ratings. Our results show that women are perceived to have more pain than men, that there was a tendency by both sexes to underestimate pain in others, but men showed even greater underestimation, and that gender role expectations of pain endurance given by the video observers accounted for substantial variance in their ratings of pain in the videos.
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                Author and article information

                Journal
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2010
                07 December 2010
                : 3
                : 241-247
                Affiliations
                [1 ] Department of Clinical Health Psychology, University of Florida, Gainesville, FL, USA
                [2 ] Spinal Cord Injury Program, Brooks Rehabilitation Hospital, Jacksonville, FL, USA
                [3 ] Department of Psychology, University of Jordan, Amman, Jordan
                [4 ] Durham VA Medical Center, Durham, NC, USA
                [5 ] Department of Psychology, Indiana University – Purdue University Indianapolis, Indianapolis, IN, USA
                Author notes
                Correspondence: Laura Wandner, University of Florida, 101 South Newell, Drive, Rm 3151, PO Box 100165, Gainesville, FL 32610-9165, USA, Tel +1 325 273 5221, Fax +1 352 273 6156, Email ldwandner@ 123456phhp.ufl.edu
                Article
                jpr-3-241
                10.2147/JPR.S14708
                3033032
                21311717
                © 2010 Wandner et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Categories
                Original Research

                Anesthesiology & Pain management

                pain, virtual human, race, age, gender, perception

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