For healthcare providers​

Thank you for all you do to help people living with chronic pain.

Improving care involves shifting the narrative from passive biomedical treatment focused on fixing pain to person-centered care, while promoting active self-management by the individual (supported by passive therapies to facilitate their participation in a self-management program). 

Person-centered, compassionate care and self-management offer numerous benefits, including improved pain management, enhanced functionality, and a higher quality of life. These benefits promote greater adherence to treatment, boost patient satisfaction, reduce provider stress and burnout, and decrease malpractice liability.​
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Five recommendations to build stronger relationships and improve outcomes
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1. Recognize our humanity.
​See us as people first. Not patients. Not pain numbers. Not appointment times. Not body parts. And not a symptom or medical diagnosis. We're more than the pain.
  • No single contributor drives pain. It's a biopsychosocial experience.
  • ​A pain score doesn't sufficiently capture the person's experience.
  • It's often the struggle with pain that is worse than the pain itself. We don't go to the doctor solely because of pain. We go because of the emotional distress from the anxiety, isolation, and depression that magnify the experience of pain and how the pain is affecting our sleep, mobility, daily activities, things that are important to us, and quality of life in general.
  • Explore how the pain is affecting a person's life to identify and address psychosocial factors, including unhelpful thoughts like catastrophizing, all-or-nothing thinking, blaming, and unrealistic expectations; unhelpful feelings like anger, fear, anxiety, helplessness, or hopelessness; and unhelpful, exaggerated, and anticipated pain behaviors like fear avoidance that could affect healing and the transition to chronic pain. Using tests such as the VA Rating Scale, the Peg Scale, the Central Sensitization Inventory, and the Pain Catastrophizing Scale might be helpful. 
  • Treat the person as an equal through shared decision-making in their care, respecting their autonomy, exploring safer and simpler treatment options, explaining the risks and benefits of treatment, and discussing potential outcomes if they choose not to act. 
  • Help the person identify what is important to them and assist them in creating goals.
  • Knowing that doing these things can take time you may not always have, try to find extra time, such as during lunch or at the end of the day, to spend more time with the person if required. The additional time you spend with them can be cost-effective in the long term, as you gain a deeper understanding of the person and their experiences.

2. Prioritize listening over speaking and listen to our stories.
The person in your office wants to be heard and believed. The pain is real. Take time to have a conversation and peel back the onion—listening to their story without interruption, suspicion, or judgment, and going beyond tick-box communication to make your office space a safe place for them to share their story, express their concerns, and ask questions. Listening helps you understand a person's experiences, values, and hopes, enabling you to find the most effective ways to assist them and empower them to help themselves.​
  • Repeat their story to them so you have it right, and they know you do.
  • While you may know the science and have the training, the person is the true expert regarding their experience. If they say the pain they're feeling is 10 out of 10, or even 15 out of 10, they aren't exaggerating.
  • Take a counseling position by asking open-ended, guiding, and reflective questions, such as: Can you tell me more about what you're going through? How is the pain limiting what you do? Do you find times when all you can do is focus on the pain? Are there times when the pain is better or worse? What are you most worried about? Do you fear that something potentially dangerous is happening in your body? What things can you do to improve your experience? And what are your goals, including your expectations for treatment?

3. Choose your words with compassion.
The words you say, how you say them, and your body posture can all affect a person's pain journey and the amount of suffering they may experience.
  • Steer clear of language that could unintentionally cause invalidation, fear, or anxiety. Phrases like "bone on bone, wear and tear, degenerative disease, you look normal, you'll be fine, the pain is in your head, there's nothing more I can do for you, and you're the worst case I've ever seen" can cause a person to feel less believed, become guarded, withdraw from activity, and focus on the worst.
  • Avoid overusing scientific language in conversations, especially when incorporating clinical jargon.
  • Use clear and straightforward language, incorporating stories and metaphors when appropriate.

4. Incorporate active self-management strategies in your recommendations.
Active self-management strategies can help create a sense of calm and active control, building confidence to enable the person to make their life bigger than the pain. The bigger their lives become, the smaller the space the pain takes in them.
  • It is done by the person rather than relying on a provider or agent, giving them greater control.
  • It requires the person to take personal responsibility, change their behaviors, and become involved in their healthcare without avoiding or escaping the pain. 
  • It shifts the provider's role to that of a coach, offering validation, supporting goal setting and skill development, encouraging behavior change, and building the person's self-efficacy. 
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5. Help make sense of pain as it transitions from acute to chronic.
People living with chronic pain want acknowledgment that the pain is real and not just in their heads. And they want a path forward. They often jump on what I call the pain merry-go-round—visiting all types of siloed providers, going through all sorts of tests and interventional procedures, taking all kinds of pills, and spending countless hours reading about their symptoms on the Internet – trying to find a cause and cure only to be disappointed in average or below average treatment results or pain that don't match any diagnostic testing or exam results.
  • Offer hope and cautious optimism. Explain that while there is no quick fix or magical treatment for chronic pain, the pain experience can change and even go away. It's possible to live well despite the pain.
  • Provide clear information and help dispel any misconceptions that are holding them back.
  • Incorporate pain neuroscience education in your patient discussions. Discuss with the person how pain works and explain why they experience their symptoms. By understanding pain, they can change their thoughts, feelings, and behaviors around it. They don't have to focus on the pain, fear it, worry about it, or avoid it. 
  • Explain how hurt doesn't necessarily mean harm. And offer evidence that the pain doesn't mean something horrible is happening in their body. It's possible to have pain with little or no tissue damage, as in the case of a paper cut, and signs of damage with no pain, as in the case of a soldier wounded in battle or findings on a diagnostic scan, such as degeneration, arthritis, bursitis, and hip and knee abnormalities, that are common in people without pain and are normal with aging, just like wrinkles and gray hair.
  • The goals should be to return to function and improve quality of life, rather than solely focusing on pain reduction or elimination. Focusing on pain reduction or elimination only adds more focus to the pain.
  • Transition from passive therapies to active self-management, using passive therapies only to facilitate participation in an active self-management program.
  • Refer to specialists like physical therapists, pain psychologists, and formal interdisciplinary pain rehabilitation programs who have the time and chronic pain expertise to help the person change the pain narrative, accept it, and adapt to it.
  • Refer to trusted and helpful resources, such as this website.

Trusted and helpful information/research
Person-centered care
​Examination and treatment
Provider education
Patient self-management education ​
​Formal pain rehabilitation
Find links to programs around the globe. 
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