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Chronic pain, credibility, and clinical practice

(Work in progress, in draft)

Abstract Chronic pain is a public health challenge, a leading cause of disability, and a source of significant emotional distress for a large percentage of the population. Although governments across the world have created explicit action plans for reducing the burden of pain and for tackling the challenges involved in its treatment, many chronic pain patients continue to be dissatisfied with the care they receive. Satisfaction with care is associated with patients feeling listened to and believed. Unsurprisingly, chronic pain patients often report having their pain testimony unfairly disbelieved and dismissed, especially when their pain is nonmalignant and/or presents with unknown etiology. My goal in this paper is to interrogate the causes of these “credibility deficits.” After a brief overview of chronic pain in the context of mainstream reductionist biomedicine, I discuss two potential causes of the credibility deficits in testimonial exchanges between pain patients and healthcare providers. The first of these—identity prejudice—is a well-recognized and well-theorized source of credibility deficits in general. The second—providers’ misconceptualization of pain—requires more explication and analysis. Acknowledging that these factors likely interact in complex ways in real-world clinical settings, I outline some ways in which person-centered approach to medicine might help tackle them both. 

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