Patient-Centered Pain Management Communication
from the Patient Perspective
Marie C. Haverfield, PhD
, Karleen Giannitrapani, PhD
, Christine Timko, PhD
and Karl Lorenz, MD
Veteran Affairs Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), California, USA;
Stanford University School of
Medicine, California, USA;
RAND Corporation, California, USA.
BACKGROUND: Pain management discussions between
patient and provider can be stressful to navigate and
greatly impact the care received. Because of the complex-
ity, emotional color, and sensitivity of pain management,
such discussions require a high degree of skill.
OBJECTIVE: To identify patients’ perspectives of patient-
centered care communication within the context of pain
DESIGN: We conducted semi-structured interviews (25–
65 min) with patients regarding their experiences with
pain assessment and management.
Participants: 36 patients (29 males, 7 females), from 3
Veteran Affairs healthcare locations. Participant age
ranged from 28 to 94 with pain intensity ranging from 0
to 10, based on the Bpain now^ numeric rating scale
report gathered at the time of the interview.
Approach: Interview transcript analysis was conducted
using the constant comparison method to produce mutu-
ally agreed upon themes.
KEY RESULTS: Elements of patient-centered care commu-
nication described by participants include judgment, open-
ness, listening, trust, preferences, solution-oriented, custom-
ization, and longevity. Patients perceive provider reciproca-
tion in openness and trust as drivers of the patient-provider
relationship, thereby enhancing positive, associated themes.
CONCLUSIONS: Findings highlight the importance of the
patient-provider relationship in patient-centered care and
offer patient-centered care communication tools for prac-
titioners to utilize, such as solution-oriented messages
and communicating trust, especially when interacting
with patients about pain.
KEY WORDS: pain; patient participation; doctor-patient communication;
relationships; qualitative research.
J Gen Intern Med
© Society of General Internal Medicine (This is a U.S. Government work
and not under copyright protection in the US; foreign copyright protection
may apply) 2018
Pain management, which affects approximately 25.3 million
can be a difficult and frustrating
experience. As a result of exposure to violence and social
disadvantages, Veterans may have a heightened experience
Medical providers are often patients’ primary re-
source to address pain concerns and access pain solutions.
However, patients and providers frequently hold differing
points-of-view, making discussions about pain a challenge.
While providers report difficulty in prescribing opioids and
trusting patients’ pain reports, patients may feel providers are
not listening to concerns and overprescribe medication.
Although this disconnect is well documented, less is known
about the communicative features of discussions that patients
perceive as helpful or hurtful to good pain care.
Patient-centered care, broadly defined as providers’ atten-
tiveness towards patient care preferences and needs,
a framework for examining communication. Patient-centered
care communication underscores engagement of patients in
decision-making, consideration of patients’ emotions, keeping
patients informed, and motivating patient self-management.
These approaches promote better patient-provider commu-
nication and improve patient outcomes including medication
adherence and satisfaction.
Less understood are the compo-
nents of communication behavior that facilitate or hinder
effective patient-centered care.
Patients’ preferences for
communication are key to understanding how providers might
improve interactions. Furthermore, due to Veterans’ potential
for experiencing pain, they may provide a unique view of what
patient-centered care communication about pain entails.
We interviewed Veteran patients to examine how they per-
ceive patient-centered care communication during discussions
with their providers about pain management. The purpose was
to enrich our understandings of patient-centered care perspec-
tives and offer insights for practitioners on communicative
approaches to high-quality pain management.
We conducted patient interviews as part of the Effective
Screening for Pain (ESP) study (2012–2017),
the VA Central IRB. We consented a convenience sample
(N = 36) of Veterans in five primary care clinics (four general
clinics and one women’s clinic in urban and rural locations),
from three VA health care systems in California, Oregon, and
Received December 13, 2017
Revised April 17, 2018
Accepted April 27, 2018