Virtual Human-Delivered Interviews for Patients With Chronic Pain: Feasibility, Acceptability, and a Pilot Randomized Trial of Standard Medical, Psychosocial, and Educational Interviews.

OBJECTIVE: Seminal advances in virtual human (VH) technology have introduced highly interactive, computer-animated VH interviewers. Their utility for aiding in chronic pain care is unknown. We developed three interactive telehealth VH interviews-a standard pain-focused, a psychosocial risk factor, and a pain psychology and neuroscience educational interview. We then conducted a preliminary investigation of their feasibility, acceptability, and efficacy. We also experimentally compared a human and a computer-generated VH voice. METHODS: Patients ( N = 94, age = 22-78 years) with chronic musculoskeletal pain were randomly assigned to the standard ( n = 31), psychosocial ( n = 34), or educational ( n = 29) VH interview and one of the two VH voices. Acceptability ratings included patient satisfaction and expectations/evaluations of the VH interview. Outcomes assessed at baseline and about 1-month postinterview were pain intensity, interference, emotional distress, pain catastrophizing, and readiness for pain self-management. Linear mixed-effects models were used to test between- and within-condition effects. RESULTS: Acceptability ratings showed that satisfaction with the VH and telehealth format was generally high, with no condition differences. Study attrition was low ( n = 5). Intent-to-treat-analyses showed that, compared with the standard interview, the psychosocial interview yielded a significantly greater reduction in pain interference ( p = .049, d = 0.43) and a marginally greater reduction in pain intensity ( p = .054, d = 0.36), whereas the educational interview led to a marginally greater yet nonsignificant increase in readiness for change ( p = .095, d = 0.24), as well as several significant improvements within-condition. Results did not differ by VH voice. CONCLUSIONS: Interactive VH interviewers hold promise for improving chronic pain care, including probing for psychosocial risk factors and providing pain-related education.

Personality and treatment-related correlates of trustworthiness: A web-survey with chronic pain narratives.

OBJECTIVES: This study examined personality and treatment-related correlates of trustworthiness in chronic pain narratives. METHODS: 727 adults participated in an online survey and rated eight narratives written by patients with chronic pain. Eighty-six percent of the participants identified themselves as having experienced chronic pain (n = 626) and 14% identified themselves as people with a medical background (n = 101). The survey examined psychological characteristics, trustworthiness and expressions of pain severity, desire for medication, and frustration with pain care. RESULTS: Pain narratives that were rated as likable, stoic, or appreciative were significantly associated with higher trustworthiness; narratives that were rated as depressed, hostile, or histrionic were significantly associated with lower trustworthiness. Similar results were found for patient peers and clinicians. Patients that expressed a high level of pain severity were rated as significantly less trustworthy (P < .001). Pain narratives that expressed frustration with pain care were also rated as significantly less trustworthy (P = .009). For pain narratives that expressed frustration with pain care, patient peers gave higher ratings of trustworthiness compared to providers (P = .008), whereas both gave similar ratings when no frustration with pain care was expressed in the narrative. DISCUSSION: Our results show that the way in which patients communicate about their pain are significantly associated with how trustworthy they are perceived. Future research should explore how trustworthiness is related to subsequent pain management and interpersonal dynamics.