PAIN AND PERCEPTION: AN INSIGHT TO AER REPORTING?
In a previous incarnation I was part of a team providing medical support to one of the UK’s major music colleges. A regular part of this was to see anxious vocal students desperately worried about their sore throats and the potential effects on their next singing test, which was almost inevitably due the following day. One joy of examining a singer’s throat is, when asked to say “aaaah” they inescapably expose the whole of the pharynx to your inspection, giving you a vista probably somewhat similar to that experienced by Jonah in his unhappy encounter with the whale! The other thing of note was that there was rarely, if ever, any signs of an acute inflammatory process sufficient to explain their reported severe symptoms. Obviously, the perception of a throat issue is different in an opera singer to us mere mortals. One might imagine this is similar to a Premier League footballer with a hamstring twinge the day before an important match: something we would ignore as trivial would be perceived as major if it could potentially affect their performance.
These musings were precipitated by a fascinating presentation from the French College of General Medicine’s 16th congress by Dr Anne Maugue. In addition to being a post-doctoral researcher in Nice, Dr Maugue is a flautist with the Monte-Carlo Philharmonic and in her lecture she was keen to raise awareness of musculo-skeletal issues in professional musicians. One only has to watch an orchestra playing to realise that the postures required probably impose stresses and strains on the body very different to those in other walks of life. When one also considers the time spent in rehearsal and performance it seems that a certain degree of pain is inevitable. Maugue quotes a prevalence of pain in members of professional orchestras between 41% and 93% and also makes a valid point about medical support: unlike elite athletes, orchestral musicians do not usually have a support team of medical professionals to turn to. But here’s the rub: as with my singers above, the perception of symptoms by the patient is often at odds with the physical findings. Maugue quoted a Danish study where musicians rated their problems for a week: when those undertaking the study looked at comparing their physical findings with the reported symptoms from the players, they found they were unable to correlate them. In a study conducted by Dr Maugue a sample of 440 orchestral musicians saw that over 60% reported musculo-skeketal pain in the preceding 7 days. She also presented data on the emotional exhaustion in these musicians. Interestingly, there is now further work being undertaken by Sports Medicine groups looking at musicians, and sports psychologists are also studying the effects of stress in this group.
There is little doubt that the perception of symptomatology can differ dramatically between groups, and if your livelihood is perceived to be at risk, the psychological pressures will only add to the issues faced. In summing up, Dr Maugue called for early treatment of these issues as being the road to potential cure, but it raises a question: how would such phycological factors effect the reporting of adverse event reactions?
The way a patient perceives and subsequently reports their symptoms can impact how healthcare professionals assess and diagnose AER’s. Healthcare professionals may have a different perception when compared to patients and, with a better understanding of the underlying disease process, may be more likely to attribute indications to the disease itself rather than to a medication. On the other hand patients may believe symptoms to be a result of a medication they are taking, even if they are unrelated, which in turn could lead to potential misdiagnosis, unnecessary treatment and incorrect data. When taking Dr Maugue’s conclusion into account, it is clear how such perceptions could differ vastly between groups of patients depending on their profession.
Incidentally, if you wish to learn a little more about the Orchestre Philharmonique de Monte-Carlo I commend you to their excellent web site on https://www.opmc.mc/en which details their upcoming programmes: you’re less likely to lose your shirt there than in the Casino down the road!