Empathy in Pain Care: Why It Matters and How to Do It Well

One critical component of effective listening is empathising.

Empathy is often described as a soft skill in healthcare. The outcome data suggest otherwise.

Empathy appears to be clinically active

A 2024 cohort study of 1,470 adults with chronic low back pain found that patients treated by more empathic physicians reported lower pain, less disability, and better quality of life over 12 months (Licciardone et al., 2024). These associations remained significant after adjusting for demographics, comorbidities, opioid use, and surgery. In that cohort, the magnitude of benefit linked to higher physician empathy exceeded that associated with nonpharmacological treatment, opioid therapy, or lumbar spine surgery.

The study was observational, so causality cannot be proven. However, the wider literature points in the same direction. A systematic review by Howick et al. (2018) found that empathic communication is associated with small reductions in pain and anxiety across experimental and clinical settings. A meta analysis by Derksen et al. (2013) similarly reported consistent links between physician empathy and improved clinical outcomes.

Empathy is not evenly distributed across healthcare professions

A systematic review and meta analysis of patient surveys by found that Allied Health Professionals scored highest on patient rated empathy (mean 45.29, 95% CI 41.38 to 49.20), whereas physicians scored lowest (mean 39.68, 95% CI 38.29 to 41.08) (Howick et al., 2017).

These differences likely reflect structural factors rather than character traits. Medical consultations are often brief and diagnostically driven. Allied Health Professionals, including physiotherapists, typically spend longer with patients and see them repeatedly over time.

If empathy improves engagement and outcomes, professions built around longer sessions and ongoing rehabilitation may have structural advantages in delivering it consistently. In persistent pain care, where progress depends on sustained participation, this may be particularly important.

What Empathising Actually Looks Like

The short animated clip from Brené Brown’s talk The Power of Vulnerability, linked below, illustrates how easily conversations drift from understanding to reassurance or fixing.

https://www.youtube.com/watch?v=1Evwgu369Jw

Animated Clip from Dr Brené Brown's full talk 'The Power of Vulnerability'

Empathising well is rarely elaborate. It is accurate and attuned, meeting someone where they are.

“I can see why you're exhausted.” “That sounds incredibly frustrating.” “That’s brutal.”

These responses signal understanding, but need to be authentic in order to be effective.

Only then do explanations, pacing strategies, and rehabilitation plans tend to be fully received.

In Short

Higher clinician empathy is associated with lower pain and better function in chronic pain populations. Validation strengthens engagement. Advice lands better after understanding. In physiotherapy, where time and repetition are built in, empathy may matter even more. Understanding first. Solutions second.

References Derksen, F., Bensing, J., & Lagro-Janssen, A. (2013). Effectiveness of empathy in general practice: a systematic review. The British journal of general practice : the journal of the Royal College of General Practitioners, 63(606), e76–e84. https://doi.org/10.3399/bjgp13X660814 Howick, J., Steinkopf, L., Ulyte, A., Roberts, N., & Meissner, K. (2017). How empathic is your healthcare practitioner? A systematic review and meta-analysis of patient surveys. BMC medical education, 17(1), 136. https://doi.org/10.1186/s12909-017-0967-3

Howick, J., Moscrop, A., Mebius, A., Fanshawe, T. R., Lewith, G., Bishop, F. L., Mistiaen, P., Roberts, N. W., Dieninytė, E., Hu, X. Y., Aveyard, P., & Onakpoya, I. J. (2018). Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis. Journal of the Royal Society of Medicine, 111(7), 240–252. https://doi.org/10.1177/0141076818769477 Licciardone, J. C., Tran, Y., Ngo, K., Toledo, D., Peddireddy, N., & Aryal, S. (2024). Physician Empathy and Chronic Pain Outcomes. JAMA network open, 7(4), e246026. https://doi.org/10.1001/jamanetworkopen.2024.6026