351: Characterising Validating and Invalidating Clinician Behaviours in Chronic Pain Consultations

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Psychology, Artificial Intelligence/Machine Learning

Background and Aims: Effective clinician-patient communication is critical in chronic pain, where symptoms are complex and subjective. As communication underpins pain assessment and treatment planning, specific clinician behaviours can shape patient outcomes. Specifically, clinician validation can strengthen trust and enhance engagement with treatment, whereas invalidation may heighten distress and contribute to poorer health outcomes. However no large‑scale analysis has comprehensively characterised patient experiences of validating and invalidating clinician behaviours in pain consultations. This study therefore aimed to identify these perceived behaviours and to examine how such experiences differ across gender and age groups.

Methods: As part of an online study, a total of 632 adults with chronic pain provided detailed autobiographical accounts of healthcare consultations they perceived as either validating or invalidating. Narratives were analysed thematically using DECOTA (Deep Computational Text Analyser), a tool that used fine-tuned large language models to identify key themes and sub-themes in free-text data. A subset of responses were independently coded descriptively by a human researcher, and triangulation of human and machine‑generated codes was conducted to ensure consistency and agreement. Ethical approval was given by the University of Southampton.

Results: Agreement was high between the codes identified by DECOTA and human analysis. Validating clinician behaviours included active listening, affirming the legitimacy of pain, and explaining causes and treatments. Invalidating clinician behaviours included interrupting patients, rushing, and minimising suffering. Some behaviours present on a validation-invalidation spectrum, e.g., eye contact vs no eye contact, physical examination vs no physical examination. Clinicians’ invalidating behaviour of ‘psychologizing’ pain was significantly more prevalent in younger and female populations.

Conclusions: This study underscores the pivotal role of clinician validation and invalidation for chronic pain. Perceived validating behaviours were characterised by active listening, legitimisation of pain, and clear explanatory communication, whereas interrupting, rushing, minimising symptoms, and psychologizing pain contributed to perceived invalidation. The DECOTA analysis also highlighted age and gender‑based inequities. These findings highlight the need for clinician training that embeds validation, authenticity, communication skills, and bias awareness.

References: N/A

Presenting Author: Hollie Birkinshaw
Submitting Author: Hollie Birkinshaw

Senior Author: Hollie Birkinshaw

IASP 2026 Global Year theme of Neuropathic Pain: No

• Amanda Lillywhite: PhD - University of Bath
• Charlotte Lee: PhD - University of Southampton
• Matthew Garner: PhD - University of Southampton
• Tamar Pincus: PhD - University of Southampton