With Gabrielle Page
You enter the exam hall already late. The next patient, someone you’ve never met, sits stiffly on the edge of the chair. Scan the chart before you sit down. Chronic back pain. Normal imaging. Multiple previous visits.
Your mind is already moving towards efficiency. What can you realistically do in the next 15 minutes?
You ask the patient to describe their pain. The patient hesitates, choosing his words carefully. You can feel the pressure of the ticking clock behind you. When you report that the imaging looks normal, you see a change in the patient. His shoulders rise. He’s out of breath. You have not rejected the patient. You didn’t say anything condescending. But the mood in the room has changed. Nothing about the patient’s spine has changed at that time. But his nervous system has and the pain flares up.
As clinicians, this is the part we rarely talk about: the suffering we can unwittingly amplify. As a psychologist and researcher who has spent years treating and studying chronic pain, I have learned that one of the most powerful drivers of pain is not always pathology. It’s the social and clinical environments we createthe assumptions we bring into the room and the social signals we send without realizing it.
Chronic pain affects more than one in five Canadians. But not all pain is generated by our bones, muscles and systems. It is also shaped by context; in a clinical setting, from the micro-interactions that unfold in every encounter. A short pause before answering. Skeptical tone. A quick explanation. The implication that nothing is a serious mistake. These indications are not neutral. The body misinterprets them as threats. And when the nervous system detects a threat, the pain intensifies. Symptoms worsen in real time.
Some clinicians argue that they cannot address every social factor influencing a patient’s pain and that time pressures make it unrealistic to investigate anything beyond symptoms and medical history. Others may argue that there is no point in asking about social factors that they cannot control or manage. These are valid concerns. However, the point is not to fix a patient’s social environment. The point is to understand that social anxiety shapes pain, avoid adding to it, and empower patients by sharing this simple fact.
Asking about social context is not a luxury. It is a clinical necessity. The science is clear: Social stress enhances pain pathways. People who do not believe experience a greater intensity of pain.
Ignoring social factors has significant costs:
- We risk misdiagnosing the problem. When we ignore the social context, we end up dealing with the wrong thing. A patient whose pain is exacerbated by financial stress, discrimination, unsafe housing, or caregiving overload may be labeled “noncompliant” or “treatment resistant.” This is clinically dangerous.
- We risk exacerbating the patient’s pain. Social anxiety is not a side note. It is a physiological enhancer. When clinicians do not ask about social pressures, they miss the very factors that drive them irritant and neuroimmune activation.
- We risk becoming a source of stress ourselves. If we don’t understand the social burden a patient carries, we are much more likely to send messages of doubt, dismissal, or impatience. These signals activate the threat response that amplifies pain.
- We risk wasting time and resources. Ignoring social factors does not save time. It creates revolving door visits, escalating investigations and chronic dissatisfaction for both patients and clinicians.
- We risk practicing outdated medicine. The science is indisputable. Pain is a biopsychosocial experience. To ignore the social dimension is to practice deficient medicine. Evidence-lagged medicine. Clinicians who do not ask about social factors are not effective. They become inaccurate.
Small changes in our care matter. Validate the patient’s description of pain. Asking a question or two about stressors. Acknowledging the lived reality of navigating pain in a world that rewards productivity and punishes vulnerability. These are not soft plugins. Recognizing the social dimension of pain is a low-cost, high-impact shift that reduces pain and improves outcomes. The alternative is to continue to exercise in ways that inadvertently worsen the very symptoms we are trying to treat.
We can’t afford it. Not for our patients. Not for ourselves. Not for our social welfare.
And it’s never too late to examine our practices and make a change. At the end of the visit, try something different. Slow down your breathing. Sit down, even for a moment, and say, “Your pain is real. What you’re describing makes sense given what we know about how pain works.” Ask about what is weighing the patient down. Notice that the volume in the room decreases. Nothing in the patient’s spine has changed. But the nervous system has. This is what real-time threat reduction looks like. A short pause, an affirming statement, a willingness to see the whole person and not just a scan.
These are small acts, but they bring about physiological improvements, build confidence and reduce pain.
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Previously Posted at healthdebate.ca with Creative Commons license
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The post The hidden cost of redundancy: How we amplify chronic pain in clinical settings appeared first on The Good Men Project.
