Can images of pain enhance patient–clinician rapport in pain consultations?

Claire E. Ashton-James*, Peter H. Dekker, Judy Addai-Davis, Tom Chadwick, Joanna M. Zakrzewska, Deborah Padfield, Amanda C. Williams

*Corresponding author for this work

    Research output: Contribution to JournalArticleAcademicpeer-review


    A variety of treatment outcomes in chronic pain are influenced by patient–clinician rapport. Patients often report finding it difficult to explain their pain, and this potential obstacle to mutual understanding may impede patient–clinician rapport. Previous research has argued that the communication of both patients and clinicians is facilitated by the use of pain-related images in pain assessments. This study investigated whether introducing pain-related images into pain assessments would strengthen various components of patient–clinician rapport, including relative levels of affiliation and dominance, and interpersonal coordination between patient and clinician behaviour. Videos of 35 pain assessments in which pain images were present or absent were used to code behavioural displays of patient and clinician rapport at fixed intervals across the course of the assessment. Mixed modelling was used to examine patterns of patient and clinician affiliation and dominance with consultation type (Image vs Control) as a moderator. When pain images were present, clinicians showed more affiliation behaviour over the course of the consultation and there was greater correspondence between the affiliation behaviour of patient and clinician. However, relative levels of patient and clinician dominance were unaffected by the presence of pain images in consultations. Additional analyses revealed that clinicians responded directly to patients’ use of pain images with displays of affiliation. Based on the results of this study, we recommend further investigation into the utility and feasibility of incorporating pain images into pain assessments to enhance patient–clinician communication.

    Original languageEnglish
    Pages (from-to)144-152
    Number of pages9
    JournalBritish Journal of Pain
    Issue number3
    Publication statusPublished - 1 Aug 2017


    • communication
    • nonverbal behaviour
    • pain assessments
    • Patient–clinician rapport


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