Provider-Provider Communication in Chronic Pain Specialist Consultations
Background: Pain is the most common complaint in primary care and is the leading cause for disability in the United States. Chronic pain, or pain lasting more than three months, is often complex and difficult to manage, causing provider distress and burnout. Patient-centered communication strategies emphasizing empathy between chronic pain patients and their providers have been shown to promote good patient-provider relationships and improve patient outcomes, but the use of these strategies for reducing provider burden in peer-based, provider-provider interactions has yet to be explored. TelePain, a weekly teleconference series in which primary care providers from the WWAMI and Oregon region receive education on how to provide evidence-based care to chronic pain patients and specialty consultation for their most complex pain patients from a multidisciplinary panel of pain specialists, is one opportunity where peer-based, provider-provider interaction occurs.
Methods: Participant observation was conducted at TelePain meetings to assess the interactions between the multidisciplinary panel of pain specialists and primary care providers during consultations. Evidence of empathetic verbal and nonverbal communication skills by the pain specialists and resulting reactions by primary care providers were recorded.
Results: The panel of pain specialists showed evidence of empathetic verbal and nonverbal communication during TelePain consultations. Verbal cues included burden acknowledgement statements such as, “This is a very difficult case,” and reassurance statements such as, “You have been doing an excellent job with this patient.” Nonverbal cues communicated through video conferencing technologies included gaze orientation to show attention and investment in the discussion, head nodding to show signs of encouragement, and body orientation to show rapport. In response to the verbal and nonverbal cues from the pain specialists, primary care providers released tension in the shoulders and jaw and reciprocated head nodding as a gesture of appreciation.
Discussion/Implications: Primary care providers seeking consultation and assistance with chronic pain patients feel many of the same emotions as a patient seeking medical care for their chronic pain including anxiety, frustration, and vulnerability. Using the teachable verbal and nonverbal communication skills of empathy currently used to improve patient-provider interactions, healthcare providers can support their peers who are treating difficult chronic pain patients. Peer support networks improve provider well-being, which can then improve patient care and reduce burnout.