Harmful words: a qualitative survey of pain clinicians' perspectives on unhelpful messages in chronic pain

Individuals living with chronic pain report experiences of stigma and invalidation, including from health professionals. Anecdotally, specialist pain clinicians must work hard to engage and treat patients who have past experiences of professionals discounting their pain, or of confusing or unsettling messaging about the cause of their symptoms. However, no study has yet explored pain clinicians’ perspectives on unhelpful clinical messaging in this area. We conducted an online qualitative survey of 165 international pain clinicians, asking about the unhelpful messages heard, and repeated, by their patients. Participants reported unhelpful messaging as prevalent and clinically impactful. Qualitative survey data was analysed using inductive reflexive thematic analysis. Five themes were generated: (1) all in your head, (2) you’re physically vulnerable, (3) an elusive fix, (4) the end of the line, (5) inadequate pain explanations. The results underscore the importance of taking a validating stance towards patients’ pain report and avoiding messages that discourage movement and exercise. Pain clinicians were reluctant to endorse multiple investigations to find an imagined ‘cause’ for pain but also disliked clinical messages that implied hopelessness about the chronic pain situation. These results can guide clinical conversations in many settings where people with chronic pain receive care. Perspective: Messages provided by clinicians to individuals living with chronic pain can be deleterious and unhelpful. Such clinical messages may invalidate pain, discourage movement, increase diagnostic uncertainty and/ or provide a fatalistic long term outlook. Improvements in pain education for clinicians are required.