Patient-centred approach in pain management: Solutions within reach?

Pain is a complex experience and subjective in nature. Pain can manifest in different ways in different people based on various factors, including emotional state, cultural context, and past experiences, due to its subjective nature. Pain management is not a unidirectional process but rather a dialogue, where health professionals can also intervene with their subjectivity. Is this subjectivity a problem? Not necessarily, provided it remains consistently patient-centred, which can be ensured through processes such as shared decision-making (SDM). In a dialogue, necessarily bidirectional, a form of symmetry can then be established, avoiding pity and while allowing, sometimes legitimate, concerns to take shape.

Concretely, what does that mean? When developing a pain management strategy, healthcare professionals must recognize their patients’ experiences, actively listen to them, and consider their distinct perspectives. Healthcare professionals can begin to manage pain more compassionately and effectively by recognizing that everyone experiences pain differently. People with pain have preferences and want to actively participate in decision-making. They want to know the options, the advantages and disadvantages as well as the expected outcomes. They want to share their views and express what matters to them. An SDM approach will give patients greater autonomy and control over how they manage their pain. In turn, compliance with treatment can be improved and patient satisfaction with care can increase.^1,2 This collaborative approach requires establishing mutually trusting patient–provider relationships by openly communicating with patients about their perceptions, pain management goals, concerns, and treatment options,^3,4 while trying to reduce stigma and judgemental attitudes. ⁵ This is important, even for experienced practitioners, as anyone can be biased in their assessment by competing factors, a diagnosis of depression shown to influence observers’ estimates of another person’s pain. ⁶

But is it realistic at a system level? In other words, does a patient-centred approach cost more? There could be economic benefits by promoting efficient use of resources from the patient’s perspective, or even specifically SDM in acute pain, instead of just following protocols. ⁷ Given that the current budget dedicated to pain management can be estimated at several billions in a country like the United Kingdom, the potential for resource reallocation is considerable. ⁸ And this budget does not include all the societal impact as many people do not use public health services. ⁹

So now is the time to invest in staff development in patient-centred strategies, one of the first being pain self-management. ¹⁰ Recommendations will need to be continuously updated, informed by research programmes restlessly adapted. People suffering from pain will be part of the solution. They can and want to be part of it. ¹¹ They are experts in what matters to them. And even technically, they have the ‘cognitive flexibility’ that one would expect from pain-free people. ¹² However, while the contribution of patients and the public to setting the research agenda is now better recognized, ¹³ obstacles persist, in particular, organizational barriers. ¹¹ We have a role there to inform services, policy makers, but also our colleagues, clinicians, and researchers.

In conclusion, although the road is still long, we have solutions at hand. They are offered to us by the most important people here, those affected by an experience of pain. All that remains is to seize the opportunity.

ORCID iD

Patrice Forget https://orcid.org/0000-0001-5772-8439