The DOI matches its Crossref record; 18 of the 19 references it cites were found in a registry or an index; 3 of the 55 sources its claims cite were checked for support.
Validating pain communication: current state of the science
Open accessAbstract
Department of Psychology and Neuroscience, Duke University, Durham, NC, USA Corresponding author. Address: Department of Psychology and Neuroscience, Duke University, 2200 W Main Street, Suite 340 Durham, NC, USA 27705Tel: (919) 416-3400; fax: 919-416-345. E-mail address: [email protected] (F. J. Keefe). Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
30 Not checked yet · 8 Own interpretation · 5 No basis given · 1 Couldn’t confirm · 1 Own result · accuracy not yet measured
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Finally, higher levels of validation were not related to patient reports of pain or symptoms of anxiety or depression.”
§ Validating pain communication: Current state of the science > Empirical studies of validation
What the sources say
- Could not verifycites [1] sourceExperimental — accuracy not yet measured
The Method (Participants; page unavailable) reports patients’ pain intensity, but the Results (Correlations; page unavailable) examine validation in relation to spouse responses to pain and relationship functioning, not patients’ pain reports. Searches for validation alongside pain intensity, anxiety, and depression found no passage assessing the claimed relationships. (LLM, conf=0.76)
- Could not verifycites [2] sourceExperimental — accuracy not yet measured
The Methods (2.1 and 2.2, page unavailable) describe patients’ pain-intensity reports and observed spousal validation, but the retrieved Results do not relate validation to pain intensity. The Procedure (2.3, page unavailable) says a mood interview was not part of this study. Searches for validation in relation to pain, anxiety, and depression found no passage establishing the claimed lack of association. (LLM, conf=0.76)
- Could not verifycites [3] sourceExperimental — accuracy not yet measured
The Methods (section 2.2, page unavailable) describe observed spousal validation, and the Participants section (2.1, page unavailable) reports patients’ pain intensity. Neither those passages nor the Discussion’s account of validation associations reports whether validation was related to pain reports, anxiety symptoms, or depression symptoms. Searches for those outcomes and their correlations with validation found no passage addressing the claim. (LLM, conf=0.74)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
In the paper
“Despite the potential benefits of validation, some research suggests that receiving social reinforcement (including validation) after sharing pain-related thoughts and feelings may be associated with worse patient outcomes such as increased pain[22].”
What the sources say
- Not checked yetcites [22]
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“One potentially important factor that has been relatively understudied until recently is the level of validation that may or may not be provided by people who are the recipients of a pain communication [4].”
What the sources say
- Not checked yetcites [4] source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“A valuable addition to the conceptualization of validation has been the growing emphasis placed on considering whether or not a person feels validated by a listener’s response.[10; 15]”
§ Validating pain communication: Current state of the science > The concept of validation
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“If a patient with pain feels understood and validated, it will likely influence their emotional state and their behaviors differently than if they perceive that others respond but do not understand them.”
§ Validating pain communication: Current state of the science > The concept of validation
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Alternatively, if validation occurs after someone discloses thoughts or feelings related to pain, this type of disclosure is likely to increase.”
§ Validating pain communication: Current state of the science > Models of validation
What the sources say
- Not checked yetcites [5] source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“There is growing recognition that pain communication is important, and the way that people (e.g. partners, healthcare providers) respond to patients sharing their pain-related thoughts and feelings may have significant implications for pain-related outcomes[8].”
What the sources say
- Not checked yetcites [8] source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“beliefs which are likely to lead to increases in psychological distress and negative affect.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Thus, if validation occurs after someone talks about their pain or shows other pain behaviors (see Figure 1, Panel A), then the likelihood of pain behaviors will increase.”
§ Validating pain communication: Current state of the science > Models of validation
What the sources say
- Not checked yetcites [5] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Without intervention, some significant others may engage in validating behaviors right after patients provide detailed descriptions of pain without realizing that these validating behaviors have the potential to reinforce maladaptive pain behaviors such as focusing on the pain, spending excessive time reclining, or over-reliance on others for assistance.”
§ Validating pain communication: Current state of the science > Models of validation
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: People with ongoing pain probably discuss it with close others, and many of those others likely respond with attention or help.
- It may state two separate claims as one. 16
- Probably not a substantial claim. 13
None of the sources cited for this claim have been checked yet.
In the paper
“According to the biosocial model, if patients receive validation after sharing pain-related thoughts and feelings, they will feel understood and accepted, will experience a reductions in emotional arousal and negative affect, and may experience a reduction in pain (see Figure 1, Panel B).”
§ Validating pain communication: Current state of the science > Models of validation
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“According to the biosocial model[12; 13], validation has a soothing effect, reduces negative affect, and “takes the steam” out of interactions with high emotional arousal.[6]”
§ Validating pain communication: Current state of the science > Models of validation
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Furthermore, validation from a romantic partner may enhance relationship intimacy, which is related to several positive benefits (e.g. increased positive affect, improved psychological well-being) [10; 11].”
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In the developing the construct of validation, Linehan describes six levels of validating behaviors that individuals (e.g. partners, friends, health professionals) may engage in (see Table 1).”
§ Validating pain communication: Current state of the science > The concept of validation
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“This model views validation as a type of social reinforcement and predicts that validation increases the likelihood of whatever behavior it follows.”
§ Validating pain communication: Current state of the science > Models of validation
What the sources say
- Not checked yetcites [5] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Both of these studies also used research assistants to deliver validation/invalidation, which contributes to high internal validity but may compromise external validity.”
§ Validating pain communication: Current state of the science > Empirical studies of validation
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Some observational studies have coded for validation and invalidation, but currently, no studies have compared observational reports of validation with self-reported feelings of validation.”
§ Validating pain communication: Current state of the science > Future directions
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Lastly, the first study[14] used healthy participants while the second study[21] used nurses who reported back pain in past six months.”
§ Validating pain communication: Current state of the science > Empirical studies of validation
What the sources say
- Not checked yetcites [14]
- Not checked yetcites [21]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“No pain rating or pain tolerance differences were found between conditions.”
§ Validating pain communication: Current state of the science > Empirical studies of validation
What the sources say
- Not checked yetcites [14]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The model (see Figure 1, Panel C) hypothesizes that when partners engage in validating behaviors after patients disclose pain-related thoughts and feelings, patients will report increased intimacy, positive affect, and relationship satisfaction; positive affective responses that in turn can lead to lower levels of reported pain.”
§ Validating pain communication: Current state of the science > Models of validation
What the sources say
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
In the paper
“Self-reported feelings of validation are a key construct in the interpersonal process model of intimacy”
§ Validating pain communication: Current state of the science > Future directions
What the sources say
- Not checked yetcites [10] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“This model hypothesizes that intimacy is a result of interactions where one person (the speaker) shares personally relevant information and another person (the listener) responds in a way that causes the speaker to feel validated, understood and cared for, which is referred to as “perceived partner responsiveness.”[10]”
§ Validating pain communication: Current state of the science > Models of validation
What the sources say
- Not checked yetcites [10] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Participants who were assigned to the validation condition reported feeling less frustrated and less angry as compared to participants who received invalidation, who reported an increase in feelings of frustration and anger.”
§ Validating pain communication: Current state of the science > Empirical studies of validation
What the sources say
- Not checked yetcites [21]
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Results showed that over the course of the experiment, participants in the validation condition maintained their positive affect, while patients in the invalidation condition reported a decline in positive affect.”
§ Validating pain communication: Current state of the science > Empirical studies of validation
What the sources say
- Not checked yetcites [14]
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These two experimental studies found changes in affect consistent with the hypotheses made by the biosocial model, while neither found changes in pain intensity over the course of the experiment.”
§ Validating pain communication: Current state of the science > Empirical studies of validation
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Participants in the validation condition also reported a significant decrease in worry while participants in the invalidation group increased in worry.”
§ Validating pain communication: Current state of the science > Empirical studies of validation
What the sources say
- Not checked yetcites [14]
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Reports of pain intensity may be considered a form of pain behavior, and the lack of change in this pain behavior does not fit with either the biosocial model or the operant conditioning model.”
§ Validating pain communication: Current state of the science > Empirical studies of validation
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“What exactly is being reinforced by validating responses (e.g. emotional disclosure, verbal reports of pain) has not been well-studied”
§ Validating pain communication: Current state of the science > Models of validation
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These models each make predictions about the influence of validation; however, it is likely that the mechanism by which validation influences patients is more nuanced than any single model captures.”
§ Validating pain communication: Current state of the science > Models of validation
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Including a neutral comparison condition, while desirable, may be very difficult since most interactions involve providing the patient with some indication that they are being understood or not.”
§ Validating pain communication: Current state of the science > Future directions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Rests on an assumption: In most interactions, patients receive some signal about whether they are understood.
In the paper
“This model focuses on the speaker’s perception of the partner’s response in addition to the actual response of the listener.”
§ Validating pain communication: Current state of the science > Models of validation
What the sources say
- Not checked yetcites [10] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Third, in couples where the partner provided higher levels of validation, patients were much more likely to engage in disclosure and much less likely to report a sense of support entitlement.”
§ Validating pain communication: Current state of the science > Empirical studies of validation
What the sources say
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The interpersonal process model of intimacy[16; 17] views intimacy as the product of a transactional process.”
§ Validating pain communication: Current state of the science > Models of validation
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“To date, validation has only been compared to invalidation and has only been delivered by a research assistant.”
§ Validating pain communication: Current state of the science > Future directions
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
The paper relies on this without support.
People with ongoing pain probably discuss it with close others, and many of those others likely respond with attention or help.
“Patients having persistent pain are likely to talk about their pain with close others, and many of these people are likely to respond with attention or assistance.”
The paper relies on this without support.
In most interactions, patients receive some signal about whether they are understood.
“most interactions involve providing the patient with some indication that they are being understood or not.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Validating pain communication: Current state of the science > Empirical studies of validation
“neither study measured aspects of the pain experience beyond pain intensity, such as non-verbal pain behaviors, pain-related disability, or interpretations about the meaning of the pain”
§ Validating pain communication: Current state of the science > Empirical studies of validation
“No pain rating or pain tolerance differences were found between conditions.”
Citations
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Metadata
- Authors
- Edmond, S. N., & Keefe, F. J.
- Affiliations
- Duke University (US)
- Venue
- Pain
- Published
- 2015-02
- Volume
- 156
- Issue
- 2
- Pages
- 215-219
- ISSN
- 0304-3959 (ISSN-L)
- PMC
- PMC4477266
- OpenAlex
- W1967177702
- Cited by
- 151
- References
- 19
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 11 · 2023: 12 · 2022: 28 · 2021: 13 · 2020: 10 · 2019: 24 · 2018: 11 · 2017: 8 · 2016: 6 · 2015: 6
- FWCI
- 18.89
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute on Aging (AG041655, R01AG041655)
- National Cancer Institute (CA131148, CA173307, R21CA173307, R01CA131148)
- National Institute of Nursing Research (R01NR013910, NR013910)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (UM1AR062800)
- National Center for Complementary and Integrative Health (UH2AT007788, R01AT007572, UH2 AT00788, AT007572)
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Keywords
- pain communication, validation, pain assessment, patient-provider communication
- MeSH terms
- Communication, Emotions, Humans, Models, Theoretical, Pain, Pain Measurement
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