Table 1.

Clinical strategies and messages around chronic pain

Unhelpful	Helpful
Repeated investigations	Principled investigations combined with an explanation of why chronic pain can be present without overt pathology
Escalating analgesia focusing on short-term pain relief	Clinical focus on long-term functioning; regular medication reviews, removing medicines as important as introducing them
Reassuring results from investigations explained as ‘there is nothing wrong’	Clarify the absence of malignant problems whilst understanding of the distressing persistence of pain symptoms. Explain findings (e.g. ‘degeneration’) in their normative context (e.g. ‘normal age-related degeneration’).
Persuading distressed patients that their pain might be caused by emotions	Explain that thoughts and feelings do not cause pain, but that psychological management may be central to living well with it.
Advising patients that they need to ‘learn to live with their problem’	Introduce the idea of self-management carefully with clear examples of how it can be done, and with referral to multidisciplinary input that can support this.