Beyond intensity: pain distribution shapes healthcare- and treatment-seeking beliefs in individuals with and without clinical pain
Pain. 2026 Nov 1;167(11):2672-2683. doi: 10.1097/j.pain.0000000000004127. Epub 2026 Oct 5.
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.
PMID:42885659 | DOI:10.1097/j.pain.0000000000004127