LAS VEGAS — Much of the failure of US pain management centers around inadequate provider-patient relationships; therefore, enhancing communication with patients is a key starting point.

Michael E. Schatman, PhD, executive director of the Foundation for Ethics in Pain Care in Bellevue, Washington, shared his advice with clinicians about enhancing communication at a session held during PAINWeek 2015. 

“Relationships between those who treat chronic pain and their patients tend to be strained and patient trust is often diminished, thus exacerbating their sense of vulnerability,” Dr. Schatman said. “Improving provider-patient communication reduces vulnerability …. and enhances outcomes.”

Dr. Schatman noted that there are many obstacles to treating patients with pain successfully. 

“There were once two players in chronic pain management: the patient and the physician,” Dr. Schatman said. However, other stakeholders now influence how these patients are managed, including insurance, pharmaceutical, hospital, medical device, and urine drug testing industries; attorneys; state medical boards; and, he noted, even the US Drug Enforcement Agency.  Media coverage has also changed the way some patients with chronic pain are being treated, he said. 

Despite these changes to the manner in which patients with pain are being treated, he assured the audience that “the obstacles can be overcome” by implementing several strategies, including shared decision making with the patient.

He cited data from a 2009 British study that summarized what patients with chronic pain said they wanted from their primary care providers: emotional/psychological support, explanation, and understanding.1 What they did not want, Dr. Schatman stressed, was more medical treatment.  In the study, he said, the authors concluded that these patients “want a psychosocial approach, which they see as superior to a biomedical approach.”

One of the ways to implement psychosocial approaches in clinical practice is by adopting the practice of patient-centered care, which is one of the fundamental measures of quality outlined by the Institute of Medicine.2  This approach originated as a patient-communication approach characterized by the appreciation of each patient as a unique human being and has been shown to enhance patient satisfaction and improve outcomes. 

“This may take additional time on the front end, Dr. Schatman cautions, “yet it saves time in the long run.”  

Also incorporating patient decision aids such as Option Grids® into practice “is a great time-saver and empowers our patients,” he said. Tools like Option Grids are designed to enhance patient confidence and encourage shared decision by helping patients and providers compare alternative treatment options.3

Dr. Schatman closed his presentation with a quote from the Greek philosopher Epictetus that highlighted the main point of his talk, which is to listen to patients and include them into their treatment decisions: “We have two ears and one mouth so that we can listen twice as much as we speak.” 


  1. Kirby K, Dunwoody L, Millar R.  What type of service provision do patients with chronic pain want from primary care providers?  Disabil Rehabil. 2009;31:1514-1519.
  2. Maizes V, Rakel D, Niemiec  JD. Integrative medicine and patient-centered care. Commissioned by the Institute of Medicine Summit on Interactive Medicine and the Health of the Public.  February 2009.  Available at: Accessed August 17, 2015.
  3. Elwyn G, Lloyd A, Joseph-Williams N, et al. Option Grids: shared decision making made easier. Patient Educ Counsel. 2013;90(2):207-212.