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How to Have Difficult Conversations About Pain Management

Resources for providers on how to have conversations about pain management with their patients.

Provider-Patient Conversations Around Pain Management

Conversations can include discussions that may require the patient to change behavior such as reducing or eliminating prescription opioids from their lifestyle can be challenging. It is completely understandable for patients to express strong feelings in reaction to these discussions. Feelings of frustration, anxiety, and/or guilt may arise within the healthcare team and patients alike.

Pain medications like opioids can become a patient’s primary coping strategy for dealing with physical, emotional, psychological and post-traumatic pain. Delivering the change message may generate strong feelings or reactions and may even be terrifying for patients and families. 

We encourage the building of a strong provider-patient rapport to facilitate these challenging conversations. Good communication that demonstrates empathy and compassion will lead to more positive clinical outcomes.

The resources that follow are intended to help healthcare teams facilitate these challenging conversations.

Educational Resources on Provider-Patient Pain Management Conversations

Oregon Pain Guidance (OPG)–Difficult Conversations

  • Visit this website to find resources to assist providers in building rapport and addressing challenging medical conversations. Resources include handouts, publications, and videos on conversations gone bad and conversations with a positive outcome.

A Provider Resource on Pain Management Conversations

  • Visit pages 34- 39 of this PDF to find questions to use with patients, recommendations for approaching and/or responding to potentially challenging patient interactions, how to respond compassionately to patients, and examples of what you might want to say to your patients.

A Guide to Difficult Conversations about Opioids for Chronic Pain

  • Watch this video from the Oregon Pain Guidance – Difficulty Conversations website to learn about how to build rapport with your patients in chronic pain who do not want to reduce opioids. Learn how to assess pain, decide on functional goals, and taper opioids in a clinically realistic scenario.

Provider guide to difficult conversations

  • This handout provides key principles, language suggestions for addressing opioids, and specific scripts to help providers navigate difficult conversations.

Difficult conversations about pain management should never be stigmatizing. Visit the Reducing Stigma section of this toolkit for more information on how to reduce opioid-related stigma: