Effective Conversations About Pain Management
Patient-provider conversations about pain management can be difficult. For some patients, opioid medications are the mainstay of their pain management strategy, so conversations around tapering or discontinuing these medicines may generate strong feelings or reactions.
Starting the Conversation
It is critical for providers to acknowledge that the pain that a patient is feeling is real. It’s also important to acknowledge any emotion that may arise during the conversation.
Here are some phrases that may help you:
- “I’m sorry you are feeling so much pain”
- “It must be difficult for you”
- “How has this pain made you feel [emotion]”
Create Shared Goals
Creating shared goals helps your conversation be patient-centered. Start by sharing your core values and principles. Examples include:
- “My goal is to practice safe medicine and follow safe prescribing guidelines”
- “I want to come up with a plan together that will help you feel better long-term”
- “I want to follow all the requirements of my clinic when it comes to pain management”
Conversations with an Aggressive Patient
Anger might be a manifestation of fear and a worry that living without prescription opioids is impossible. It can be helpful to consider the factors that may underlie the strong emotional response. Asking the patient to share their concerns, building trust, and starting these conversations slowly can be very helpful.
It is also important for providers to recognize that they may be uncomfortable in these conversations.
Here are some tips and strategies for talking with an aggressive patient:
- Remember that you are not expected to tolerate harmful language. Reflect emotion and show empathy.
- Demonstrate calmness. Try not to become upset or raise your voice
- Show empathy and respect. Offer validation and support to your patient.
- Practice active listening, and show the patient you hear them. This does not mean that you have to agree with them.
- Don’t make promises you cannot keep.
Note:
When initiating pain management for acute pain, review any consent forms or policies your clinic or state has regarding opioid prescribing. In Michigan, this includes the “Start Talking” consent form and checking the MAPS record. Discuss how you and your clinic will manage any prescriptions or referrals. This might include a provider-patient agreement, and it might also include a discussion of how you will assess the effectiveness of the medications and when you would consider tapering and deprescribing.
Assessing your patient’s goals
Ask the patient what their goals are for their pain management and properly set realistic expectations.
Here are some good conversation starters:
- “Tell me what would improve your quality of life”
- “What are the things you would like to be able to do again?”
- “Where do you see yourself in a year?”
- “Tell me about your expectations regarding your pain management?”
- “What other pain medications have you tried in the past?”
Patients may have concerns about their situation. Give them an opportunity to voice their concerns and properly address them.
Here are some ideas:
- “What are your concerns about taking less opioids?”
- “What do you think is keeping you from this goal?”
When gathering this information, remember to validate and discuss their responses and any emotions that may arise. This information can help you navigate the conversation and keep it patient-centered.
Use Ask-Tell-Ask when providing information
There may be a point in the conversation where you need to address a misconception or information gap. Ask-Tell-Ask is an effective strategy to provide information.
Ask: First ask for permission to give information
Example: It may be helpful to discuss how opioids work in the body. Is it ok if we talk about this?
Tell: After the patient gives permission to discuss, give a short explanation. Focus only on what would be helpful to the patient, and use tentative language when possible.
Example: When someone takes opioids regularly, their body starts needing more and more opioids to manage pain. The higher the opioid dose, the more likely the person can overdose.
Ask: Ask how they feel about this information. Maybe this helped them understand a misconception, or left them feeling confused. This can help steer the direction of the conversation.
Example: What are your thoughts about this?
When discussing risk, focus on the opioid medications
Keep the conversation focused on the opioid medications when you talk about risk. This can help reduce stigma.
Instead of saying: “Your risk of overdose will increase if you keep taking opioids”
Say: “Opioids can carry risks, such as overdose if someone is on them long term.”
Focus on what you are willing to do, not what you refuse to do.
It’s ok to have boundaries when it comes to prescribing, but make sure your patient knows what you can do to help them.
“Based on the information I have, non-medication options are my recommendation. I’d like to discuss what this might look like for you instead of opioids.”
Practice conversation scenarios
These conversations require skill. Practice is the best way to gain more confidence in them. Below are several resources that can help you prepare for the variety of conversations you will have with patients.
Additional Resources and Trainings
Starting conversations with patients about opioid tapering
This resource gives several conversation starters about opioid tapering as well as tips for a good conversation.
Effective Conversations
CDC – “conversation starter” Video
Video regarding tapering of opioids and how to discuss this subject with patients.
Effective Conversations
CDC – “conversation starter” Hand-Out
Hand-out regarding tapering of opioids and how to discuss this subject with patients.
Effective Conversations
American Institutes for Research – Managing Difficult Conversations
A knowledge Hub focused on better chronic pain management and safer opioid use – this 2-page PDF shares actionable tips to promote effective conversations.
Effective Conversations
Provider guide to difficult conversations
This handout provides key principles, language suggestions for addressing opioids, and specific scripts to help providers navigate difficult conversations.
Effective Conversations
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.
Effective Conversations
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.
Effective 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.
Effective Conversations