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A Different Perspective to Explain Challenges in Patient-Provider Communication

With no clear evidence to improve talking about biopsychosocial elements of chronic pain, the authors propose one research perspective.

A PPM Brief

Approaching pain from a biopsychosocial perspective, while central to chronic pain management, is often a challenge for both patients and their healthcare providers. Being able to have meaningful conversations about social and psychological factors that may contribute to chronic pain, however, can be an essential part of encouraging patients to take their disease in their own hands, according to a recent paper published in the Scandinavian Journal of Pain.1

When patients focus too much on the physical manifestations of pain and remain unaware of the biopsychosocial aspects that could actually help them improve their disability, providers may dismiss patients’ candidacy for certain rehabilitation programs. In addition, as an invisible illness, chronic pain is difficult to discuss leaving some patients labeled as malingering or hypochondriacs, for example. Unfortunately, the current literature does not offer sufficient data to help pinpoint these types of difficulties, nor does it answer how both patients and providers can enhance patient-provider communication.

This is where Baukje Stinesen’s work comes in. A researcher at the HU University of Applied Sciences Utrecht and the Department of Rehabilitation Medicine at the School for Public Health and Primary Care (CAPHRI) at Maastricht University, The Netherlands, Stinesen spoke to PPM about her take. “Talking to patients about how they could deal with their pain in a different way can be difficult. But what is it exactly that patients seem to resist?” she said. “[The] resistance [that] healthcare professionals perceive does not necessarily reflect a patient’s lack of motivation to approach pain from a biopsychosocial perspective. Rather, patients may resist certain messages that practitioners implicitly and unintentionally convey when formulating potential psychosocial explanations of the patient’s pain.”

Patient-provider relationships come with their challenges surrounding talking about chronic pain. (Source: 123RF)

In his theoretical article, Stinesen and coauthors introduce discursive psychology (DP) to gain a better understanding of these implicit messages that are available in patients’ and practitioners’ talk about chronic pain rehabilitation. This type of discourse analysis focuses on the features of how people talk and how performing social practices take part in a specific interaction.

The focus of DP lies in how psychological categories (i.e., attitudes, intentions, perceptions) build up and are used by people as they talk to each other. In their article, the authors show that a DP examination of conversations in a particular context provides insights into the specific interactional sensitivities in that context. For example, such an examination shows how participants in a conversation manage the potential unfavorable inferences of their talk. They may do so, for example, by carefully choosing particular words to describe something.

The authors concluded that such insights may contribute to a better understanding of particular difficulties in patient–provider interactions about chronic pain, shedding new light on perceived patient resistance. “It is important to emphasize that patients’ interactional concerns do not simply follow from the delicate nature of social and psychological explanations as such, but rather are bound up with how such explanations are delivered by the practitioner,” they wrote in their published study.

Read More:

Fear-Avoidance and Chronic Pain: Helping Patients Stuck in the Mouse Trap

Chronic Pain and the Psychological Stages of Grief

Chronic Pain and Psychopathology in the Veteran and Disadvantaged Populations

Last updated on: September 3, 2019
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