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Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_2 | Pages 9 - 9
1 Feb 2018
Serbic D Ferguson L Smith M Thomas G Pincus T
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Purpose of the study and background

Although pain is usually described as a private experience, how pain is understood and responded to by others is important. A crucial feature of this process is empathy. The aim of this study was to examine the relationship between empathy for pain and observers' health anxiety and fear of pain. The role of the observer's sex and age were also examined.

Methods and results

In this study 159 participants (73 males, mean age=41, SD=19.6) were presented with 16 images of individuals in pain (8 female, 8 male), and subsequently rated their empathy towards them. Participants then completed the fear of pain and health anxiety measures. Both fear of pain and health anxiety were positively associated with empathy for pain, but in the regression model only fear of pain was a significant positive predictor of empathy for pain (p< .001). Further analysis revealed that when controlling for the effects of fear of pain, the correlation between health anxiety and empathy became non-significant. The same results were found when the overall empathy for pain score was split into empathy for male and female images. Observers' sex and age were not significant predictors of empathy for pain.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_6 | Pages 2 - 2
1 Feb 2016
Serbic D Pincus T
Full Access

Statement of the purposes of the study and background:

Low back pain (LBP) is the leading cause of disability worldwide, and greater understanding of mechanisms leading to increased disability in LBP is necessary. Pain-related guilt and in particular social guilt (one type of pain-related guilt) has recently been linked to greater depression, anxiety and disability in LBP. Research has also shown that greater acceptance of pain is associated with less pain intensity, depression, pain-related anxiety and disability, and with greater daily activity and overall wellbeing in chronic pain patients. The current study aim was to understand the relationship between pain-related guilt and pain-related acceptance in LBP.

Summary of the methods used and the results:

The study examined the relationship between pain-related guilt and pain-related acceptance in a sample of 287 LBP patients. A series of hierarchical multiple regression analyses were conducted in which known correlates of pain-related acceptance (pain intensity, disability, depression and anxiety) were controlled for, with the objective of testing whether pain-related guilt explains any unique variance in pain-related acceptance. Social guilt was the strongest predictor of reduced pain-related acceptance in all analyses.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_2 | Pages 11 - 11
1 Feb 2015
Serbic D Pincus T
Full Access

Purpose of the study and background

Patients' beliefs about the origin of their pain and their cognitive processing of pain-related information have both been shown to be associated with poorer prognosis in low back pain (LBP), but the relationship between specific beliefs and specific cognitive processes is not known. The aim of this study was to study the relationship between diagnostic uncertainty and recall bias in two groups of chronic LBP patients, those who were certain about their diagnosis, and those who believed that their pain was due to an undiagnosed problem.

Summary of the methods used and the results

Patients (N=68) endorsed and subsequently recalled pain, illness, depression and neutral stimuli. They also provided measures of pain, diagnostic status, mood and disability. Both groups exhibited a recall bias for pain stimuli, but only the group with diagnostic uncertainty additionally displayed a recall bias for illness-related stimuli. This bias remained after controlling for depression and disability. Sensitivity analyses using grouping by diagnosis/explanation received supported these findings. Higher levels of depression and disability were found in the group with diagnostic uncertainty, but levels of pain intensity did not differ between the groups.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_2 | Pages 28 - 28
1 Feb 2015
Serbic D Pincus T Fife-Schaw C Dawson H
Full Access

Purpose of the study and background

In the majority of low back pain (LBP) patients a definitive cause for back pain cannot be established; consequently, many patients report feeling uncertain about their diagnosis. They also experience pain-related guilt, which can be divided into: social guilt, managing pain guilt and verification of pain guilt. This study aimed to test a theoretical (causal) model, which proposed that diagnostic uncertainty leads to pain-related guilt, which leads to depression, anxiety and finally to disability.

Summary of the methods used and the results

Structural equation modelling was employed to test this model on 438 participants with LBP. The model demonstrated an adequate to good fit with the data. Diagnostic uncertainty predicts all three types of guilt. Verification of pain guilt predicts disability, managing pain guilt predicts anxiety, while social guilt was the strongest predictor of negative outcomes, predicting depression, anxiety and disability.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_4 | Pages 13 - 13
1 Feb 2014
Serbic D Pincus T
Full Access

Purpose of the study and background:

Identifying mechanisms that mediate recovery is imperative to improve outcomes in low back pain (LBP). Qualitative studies suggest that guilt may be such a mechanism, but research on this concept is scarce, and reliable instruments to measure pain-related guilt are not available. We addressed this gap by developing and testing a pain-related guilt scale (PGS) for people with LBP.

Summary of the methods used and the results:

Two samples of participants with LBP completed the scale and provided data on rates of depression, anxiety, pain intensity and disability. Three factors were identified using exploratory factor analysis (n=137): ‘Social guilt’ (4 items) relating to letting down family and friends; ‘Managing condition/pain guilt’, (5 items) relating to failing to overcome and control pain; and ‘Verification of pain guilt’, (3 items) relating to the absence of objective evidence and diagnosis. This factor structure was confirmed using confirmatory factor analysis (n=288), demonstrating an adequate to good fit with the data (AGFI= 0.913, RAMSEA= 0.061). The PGS subscales positively correlated with depression, anxiety, pain intensity and disability. After controlling for depression and anxiety the majority of relationships between the PGS subscales and disability and pain intensity remained significant, suggesting that guilt shared unique variance with disability and pain intensity independent of depression and anxiety. High levels of guilt were reported by over 40% of patients.