Observers’ impression of the person in pain influences their pain estimation and tendency to help

Background
Estimation of a patient's pain may have a considerable impact on the level of care that patient receives. Many studies have shown that contextual factors may influence an observer's pain estimation. Here, we investigate the effect of an observer's impression of a person in pain and justification of his/her pain on the observer's pain estimation, tendency to help and perceived empathy.

Methods
Thirty healthy individuals (half females) read scenarios aimed to manipulate the reader's impression of characters who ultimately were fired from their work (four positive characters and four negative; half females). Then they observed 1‐s videos of four levels of pain expression (neutral, mild, moderate, strong) in those characters during an examination. Subsequently, they rated pain estimation, tendency to help and perceived empathy. Afterwards, they rated their likability of characters and how just they find the end of story.

Results
People rated pain in positive characters higher than the pain in negative characters. They also expressed more tendency to help and a higher level of perceived empathy towards positive characters than negative characters. For the highest level of pain in positive characters, perceived injustice towards that person was the best predictor of the observer's pain estimation, tendency to help and perceived empathy. For negative characters, dislikeability was the best predictor of tendency to help and perceived empathy. Justification of their pain was a predictor of pain estimation and tendency to help.

Conclusion
Observers used different information to evaluate pain in positive and negative individuals.

Significance
Observers’ estimation of pain, perceived empathy and tendency to help biases by their understanding of the characteristics of the person in pain. In clinical settings, these biases may influence the quality of care and well‐being of patients. Understanding the underlying mechanisms of these biases can help us improve the quality of care and control the effect of prejudices on pain assessment.