UC San Diego

Background: Chronic pain is highly prevalent, economically burdensome, and one of the most common reasons for seeking medical care in the United States (U.S.). Empathic communication is an understudied phenomena in pain management with potential to alleviate the psychological and affective burdens associated with chronic pain and improve pain outcomes.Methods: This dissertation consists of three studies investigating empathic communication in physical therapy pain management care. Study 1 conducted a qualitative meta-synthesis of physical therapist preferred communication behaviors in pain rehabilitation. Study 2 used conversation analysis to investigate how empathic communication was enacted by physical therapists. Study 3 calculated the frequency of empathic communication in the study sample and used repeated-measures, conditional linear mixed-effects models to determine if physical therapist empathic communication was associated with changes in pain intensity and interference across time. Studies 2 and 3 collected original data using a longitudinal observational study design of up to 4 audio recorded physical therapy visits and 4 repeated measures for patients with chronic musculoskeletal pain over 6 weeks of routine care in an outpatient private practice Results: Study 1 found empathic communication to be one of eight preferred communication behaviors for physical therapists. Study 2 revealed three patterns physical therapists use to provide empathic support to patients expressing emotion. Study 3 found that across 99 recorded visits, physical therapists responded empathically 67% of the time. A significant interaction between empathic communication and time indicated that more frequent empathic communication was associated with a greater reduction in pain intensity across time. Conclusion: Physical therapists were found to be empathic when managing patients with chronic pain and enacted empathic support in ways that met goals for physical therapy care. More frequent empathic communication by physical therapists was associated with lower ratings of pain intensity and interference by patients. Higher empathy was also associated with larger and more rapid decreases in pain intensity over time. These findings provide rationale for future clinical trials to investigate the efficacy of empathic communication training for physical therapists who manage patients with chronic pain, an innovative approach to improving conservative pain management.