Chronic Pain Requires a Long-Term Relationship with your Health Care Team

long term relationshipHistorically, pain has been treated in accordance with the traditional biomedical model. In this model the physician sets the agenda for the visit and directs the dialogue within the visit, the values associated with health are often those of the physician and need to be adopted by the patient, and the role of the physician is that of health guardian for the patient. 1 Communication is typically one-directional with the physician telling the patient what he or she needs to do. Such interactions make sense when strict adherence to the physician’s orders results in a cure or reliable outcome.

 

In the case of chronic pain, where cures are rare and outcomes varied and limited, the traditional model is likely to fall short of the hopes of both the patient and provider. In fact, for most forms of chronic pain, the evidence supports patients taking an active role in the clinical process with goals being jointly agreed upon, values jointly explored, and the physician serving as a knowledgeable advisor rather than a guardian. Sometimes this latter perspective is called “patient-centered,” but in actuality it is more “relationship-centered,” focusing on the cooperative nature of the exchange and placing value on the resources that each party brings to the process of managing pain. Inherent to a relationship-centered approach is the notion that this will be an ongoing relationship that will have ups and downs and requires nurturing and maintenance, just like any interpersonal relationship that you might have with friends or family. It also suggests that the relationship involves not only the patient and physician, but could include a multi-disciplinary team (e.g., nurses, physical therapists, occupational therapists, psychologists, etc.), each with expertise in pain.

 

The Community Pain Center offers educational resources for working productively with your physician and/or team of health professionals in a relationship-centered manner. These include educational videos, self-management tools for tracking progress, and resources to aid in making important behavioral and life-style changes in support of better pain management.

 

1 Roter D. The enduring and evolving nature of the patient-physician relationship. Patient education and counseling. 2000;39(1):5-15.