Patients suffering from chronic pain, for example, look to doctors to understand a condition they can’t adequately describe or understand themselves. By interpreting specific medical, psychological and behavioral cues, doctors seek the best treatment plans for this perplexing and frustrating condition. Everything from facial expressions and posture to race and gender may play a role in what a doctor prescribes to treat chronic pain.
Adam Hirsh, Ph.D., associate professor of psychology in the School of Science at IUPUI, uses virtual-human technology to better understand how doctors respond to chronic pain complaints.
Hirsh, whose research focuses on the biopsychosocial aspects of pain, is one of four researchers examining the treatment process for chronic pain patients. Working under an IU Collaborative Research Grant (IUCRG), the group uses virtual patients and physician interviews to better understand what influences treatment plans and how doctors respond to each patient individually.
“We know certain patients are treated less well. There’s some evidence in the literature that women get treated differently than men. There’s also good evidence that black patients get treated differently for their pain when compared to white patients,” Hirsh said.
Researching these doctor-patient interactions isn’t easy. Studying medical records provides specific information but does not provide the controls a researcher needs. Did a patient’s gender affect treatment, or were other factors not in the record involved? Interviews and “tests” using written vignettes provide controlled data, but not a realistic environment.
The virtual-human system draws on technologies similar to those used to create computerized “avatars,” or game characters. Using the technology, Hirsh has created a website that makes it convenient for physicians to participate in the study. He began this work as a graduate student at Florida, where he used actors to simulate chronic conditions. However, that system proved unreliable once gender and race influences were considered.Because the data involved can be subjective, Hirsh has been working with computer engineering colleagues at the University of Florida, where he received his doctorate in clinical and health psychology, to develop virtual-human technology that simulates a realistic and controlled research environment.
The IUCRG-funded study uses still-frame images—extracted from full-motion animations—of a series of patient faces. The technology enables Hirsh to manipulate the “pain face”—features of the face that research has shown represent pain. The physician at the computer also is given a written description of the patient’s complaints and history.Armed with this information, physicians are asked to rate the amount of pain the patient is experiencing and indicate what treatments they would use for the patient. For example, how likely are they to prescribe an opioid pain medication or to refer the patient to a pain specialist?
More than 100 providers have completed the online work, with about 20 also participating in in-person interviews that allow the researchers to supplement the quantitative data with rich qualitative data, according to Hirsh.
While the current research data is being analyzed, Hirsh is working to improve the virtual patients to incorporate full-motion animation of their entire bodies. This would allow additional pain cues such as how the patient sits or shifts weight and how much he or she weighs.
In the meantime, Hirsh said, “across all the interviews the main thing that physicians can’t say enough about is how important chronic pain management is, and how challenging they find it to be,” whether due to lack of time with patients, inadequate treatment options or patients’ lack of resources to access available treatments.
-This article was adapted from the 2011 Indiana University Annual Report.