The Patient–Provider Relationship in Chronic Pain Management: Where Do We Go From Here?

Ask any clinician which patients he or she considers the most difficult to manage, and odds are patients with chronic pain will top the list. Anecdotal reports abound detailing the challenges such patients pose for providers. The limited published research in patient–provider communication in chronic pain care corroborates these anecdotal reports, telling of adversarial, unproductive clinic visits, often characterized by competing demands between patients and providers [1], struggles for dominance and control [2], and mutual lack of trust [3]. Research has described a “burdened physician–patient relationship”[4] and power struggles between patients with chronic pain and their providers [2,5]. Such problematic relationships pose significant challenges for providers, who have described caring for patients with pain as a “thankless” task, in which they are “confronted with failure” every day [5]. In managing patients with fibromyalgia, physicians described interactions as time-consuming, demanding, and emotionally challenging [4]. In a VA study, 73% of providers surveyed considered caring for patients with chronic pain a “major source of frustration”[6]. Patients, too, feel the relational strain prevalent in chronic pain care. In one study, female patients with chronic pain described actively working to establish credibility with their physicians, characterizing their interactions as “strenuous,”“complicated,” and “heavy.”[3] Patients may experience stress, depression, anxiety, and feelings of alienation when PCPs do not believe their pain complaints or when they perceive that they have not received adequate information about their condition and its treatment [5,7,8]. Staiger et al. found that when patients with back pain disagreed with their physicians about the cause of their pain, or the recommended diagnostic and treatment plans, patients reported decreased satisfaction with care …