You have already gone to the exam room behind schedule. The next patient, whom you have never met, sits stiffly on the edge of the chair. Scan the chart before you sit down. Chronic back pain. General imaging. Multiple prior visits.
Your mind is already moving towards efficiency. What can you realistically do in the next 15 minutes?
You ask the patient to describe his pain. The patient hesitates, choosing his words carefully. You can feel the pressure of the ticking clock behind you. When you note that imaging looks normal, you see changes in the patient. His shoulders go up. His breathing slowed. You did not dismiss the patient. You didn’t minimize. But the mood in the room has changed. At that moment nothing had changed in the patient’s spine. But his nervous system is there, and the pain is flaring up.
As clinicians, this is the part we rarely talk about: the pain we can unintentionally exacerbate. As a psychologist and researcher who has spent years treating and studying chronic pain, I have learned that one of the strongest drivers of pain is not always pathology. it is The social and clinical environment we createThe assumptions and social cues we bring into the room are transmitted without us even realizing it.
Chronic pain affects more Canadians are one in five. But not all pain is shaped by our bones, muscles and systems. It also happens Shaped by context; In a clinical setting, by the micro-interactions that unfold in each encounter. A short pause before answering. A skeptical tone. A quick explanation. The implication is that nothing is seriously wrong. This signal is not neutral. The body misinterprets them as threats. And when the nervous system detects a threat, the pain intensifies. Symptoms worsen over time.
Some clinicians argue that they cannot address every social factor influencing a patient’s pain, and that time pressures make it impractical to explore anything beyond symptoms and medical history. Others may argue that there is no point in asking about social factors that they cannot control or manipulate. These are valid concerns. Yet the point is not to fix the patient’s social environment. The point is to understand that social pressures shape pain, avoid adding to it, and empower patients by sharing this simple truth.
Asking about social context is not a luxury. This is a clinical necessity. The science is clear: Social pressure paves the way for pain. Unbelievers experience more pain intensity.
Ignoring social factors has significant costs:
- We risk misdiagnosing the problem. When we ignore the social context, we are dealing with the wrong thing. A patient whose pain is exacerbated by financial stress, discrimination, unsafe housing, or caregiver overload may be characterized as “noncompliant” or “treatment-resistant.” It is medically dangerous.
- We risk worsening the patient’s pain. Social pressure is not a side note. It is a physiological enhancer. When clinicians don’t ask about social stressors, they miss driving factors Nociceptive and neuroimmune activation.
- We risk becoming a source of stress ourselves. If we don’t understand the social load a patient is carrying, we are more likely to send signals of suspicion, dismissal, or impatience. These signals activate a threat response that increases pain.
- We risk wasting time and resources. Ignoring social factors does not save time. This creates revolving-door visits, increased scrutiny, and chronic dissatisfaction for both patients and physicians.
- We risk practicing old medicine. Science is unequivocal. Pain is a biosocial experience. Ignoring the social dimension is incomplete medicine practice. Evidence backs that medicine. Physicians who do not ask about social factors are not being efficient. They are being wrong.
Small changes in our care. Verifying the patient’s description of their pain. Asking a question or two about stress. Acknowledging the lived reality of navigating pain in a world that rewards productivity and punishes weakness. These are not soft extras. Recognizing the social dimensions of pain is a low-cost, high-impact change that reduces suffering and improves outcomes. The alternative is to continue practicing in a way that inadvertently worsens the symptoms we are trying to treat.
We can’t afford it. Not for our patients. Not for themselves. Not for our social welfare.
And it’s never too late to examine and change our practices. At the end of the visit, try something different. Slow down your own breathing. Even sit for a moment and say: “Your pain is real. What you’re describing makes sense from what we know about how pain works.” Ask about what the patient has been weighing on. Notice the reduced tension in the room. Nothing changed in the patient’s spine. But there is a nervous system. What it looks like to reduce threats in real time. A brief pause, a valid statement, a desire to see the whole person rather than just a scan.
These are small tasks, but they bring physiological improvement, build trust and reduce suffering.
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Previously published with on healthdebate.ca Creative Commons License
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