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Peer-reviewedCC BY-NC-ND 4.0Pain

Beyond intensity: pain distribution shapes healthcare- and treatment-seeking beliefs in individuals with and without clinical pain

  • Tom Frankenstein1
  • Sophia Intert1
  • Tibor M. Szikszay1
  • Michał Katra2
  • Bernhard Elsner1,3
  • Robert C. Coghill4,5,6
  • Kerstin Luedtke1
  • Waclaw M. Adamczyk1,2
6 affiliations
  1. 1University of Luebeck, Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Luebeck, Germany
  2. 2Institute of Physiotherapy and Health Sciences, Academy of Physical Education, Katowice, Poland
  3. 3Fraunhofer Research Institution for Individualized Medical Technology and Engineering IMTE, Luebeck, Germany
  4. 4Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
  5. 5Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
  6. 6Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Abstract

Pain is commonly described in sensory terms, yet its spatial characteristics are rarely quantified. We investigated whether lay beliefs about pain distribution influence theoretical decisions to seek care and treatment preferences. In a cross-sectional survey (N = 503; 49% reporting pain), participants completed thought experiments in which both visually presented pain distribution patterns (small, moderate, or large) and pain intensity (Numerical Rating Scale scores: 2, 5, 8/10) were systematically varied. For each scenario, they rated the likelihood of (1) seeking professional help (LoSH) and (2) taking analgesic medication (LoTM) on 0 to 100 scale. Participants also completed a spatial–intensity trade-off task, in which they chose between a fixed 20% reduction in intensity and variable reductions in pain distribution (20%-80%). A reversed version contrasted a fixed 80% reduction in pain distribution with variable reductions in pain intensity. LoSH and LoTM increased significantly with greater pain distribution (P < 0.001), mirroring the gradient observed for pain intensity. In the spatial–intensity trade-off task, participants' choice followed a sigmoid-like function (P < 0.001): 1% reduction in intensity was treated as equivalent to approximately a 3% reduction in distribution, indicating a systematic valuation of pain distribution. This ratio was lower in individuals experiencing pain compared with pain-free individuals. Moreover, 61% reported that pain distribution should be routinely considered in pain management alongside intensity. Results suggest that pain distribution is not merely a trivial descriptor, but a meaningful determinant of healthcare-related decision-making beliefs. Incorporating spatial metrics into clinical assessment and research may better capture how individuals implicitly evaluate pain severity.

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Cite

BibTeXRIS
BibTeX
@article{frankenstein2026beyond,
  title = {{Beyond intensity: pain distribution shapes healthcare- and treatment-seeking beliefs in individuals with and without clinical pain}},
  author = {Tom Frankenstein and Sophia Intert and Tibor M. Szikszay and Michał Katra and Bernhard Elsner and Robert C. Coghill and Kerstin Luedtke and Waclaw M. Adamczyk},
  journal = {Pain},
  year = {2026},
  month = oct,
  doi = {10.1097/j.pain.0000000000004127},
  url = {https://doi.org/10.1097/j.pain.0000000000004127},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Beyond intensity: pain distribution shapes healthcare- and treatment-seeking beliefs in individuals with and without clinical pain
AU  - Tom Frankenstein
AU  - Sophia Intert
AU  - Tibor M. Szikszay
AU  - Michał Katra
AU  - Bernhard Elsner
AU  - Robert C. Coghill
AU  - Kerstin Luedtke
AU  - Waclaw M. Adamczyk
PY  - 2026
DA  - 2026/10/05
JO  - Pain
DO  - 10.1097/j.pain.0000000000004127
UR  - https://doi.org/10.1097/j.pain.0000000000004127
AB  - Pain is commonly described in sensory terms, yet its spatial characteristics are rarely quantified. We investigated whether lay beliefs about pain distribution influence theoretical decisions to seek care and treatment preferences. In a cross-sectional survey (N = 503; 49% reporting pain), participants completed thought experiments in which both visually presented pain distribution patterns (small, moderate, or large) and pain intensity (Numerical Rating Scale scores: 2, 5, 8/10) were systematically varied. For each scenario, they rated the likelihood of (1) seeking professional help (LoSH) and (2) taking analgesic medication (LoTM) on 0 to 100 scale. Participants also completed a spatial–intensity trade-off task, in which they chose between a fixed 20% reduction in intensity and variable reductions in pain distribution (20%-80%). A reversed version contrasted a fixed 80% reduction in pain distribution with variable reductions in pain intensity. LoSH and LoTM increased significantly with greater pain distribution (P < 0.001), mirroring the gradient observed for pain intensity. In the spatial–intensity trade-off task, participants' choice followed a sigmoid-like function (P < 0.001): 1% reduction in intensity was treated as equivalent to approximately a 3% reduction in distribution, indicating a systematic valuation of pain distribution. This ratio was lower in individuals experiencing pain compared with pain-free individuals. Moreover, 61% reported that pain distribution should be routinely considered in pain management alongside intensity. Results suggest that pain distribution is not merely a trivial descriptor, but a meaningful determinant of healthcare-related decision-making beliefs. Incorporating spatial metrics into clinical assessment and research may better capture how individuals implicitly evaluate pain severity.
SN  - 0304-3959
SN  - 1872-6623
ER  -