Professor Helen Slater is a Clinical Researcher and Specialist Musculoskeletal Physiotherapist at Curtin University (School of Allied Health)
As clinicians, we want to help people experiencing pain, and apply well, what we’ve been trained to do. Yet, pausing and reflecting on clinical encounters with people living with chronic pain, there’s often a quiet tension: we are trying to inform care, while the person in front of us is trying to be understood.
Clinical expertise alone is not what people living with chronic pain need most from us. What they most value often begins well before diagnosis, treatment plans or management.
Before anything else: Listen deeply and understand their experience
At the clinical point of care, one of the most powerful approaches to care we have, is how we listen to the person and meet them where they are at.
We know from our recent research, that people living with chronic pain consistently prioritise being believed, heard, and validated. Yet, their pain experience is often invalidated and they feel misunderstood.
When we overlook or unintentionally dismiss their unique pain experience, we can erode trust before care has even begun.
So, as a clinician, the starting point is guided by what most matters to people experiencing chronic pain, when they seek pain care. These are called pain care priorities and include:
- slowing down,
- listening deeply without interrupting,
- acknowledging the impact of their pain on all aspects of their lives.
These are foundational to everything that follows in a clinical interaction.
Rethinking what good care looks like
Pain care priorities can challenge the way many of us were trained as clinicians.
People with chronic pain are not asking us to focus narrowly on tissue-based problems, their scans, or even to eliminate symptoms or “fix” them.
More commonly, people are asking for care that reflects the complex, lived reality of their chronic pain experience — across all aspects of their lives, including physical, psychological and social domains, and taken with their day-to-day contexts.
At the point of care, this means effective clinical interactions look less like delivering a solution or ‘fix’, and more like:
- making sense of the person’s story with them,
- exploring what matters in their life,
- working collaboratively toward meaningful goals,
- shared planning decisions.
This shifts from the conversation from, “What’s the matter?” to “What matters to you?”
Communication as a clinical skill
People living with chronic pain, place empathic communication at the centre of good care.
People want:
- respectful, non-judgemental, validating conversations,
- clear explanations that make sense in their realities and contexts,
- and a sense of psychological and cultural safety.
As clinicians, we often assume that effective communication is something we naturally develop.
However, it’s not that easy. Poor communication undermines care and trust, no matter how clinically-sound our decisions are. Empathic communication, on the other hand, builds trust, engagement, and a shared understanding, all of which are fundamentals for long-term conditions like chronic pain.
Partnership, not hierarchy
Another clear message from people with lived experience is the importance of partnership.
At the point of care, this means letting go of the traditional model, where the clinician is the sole expert. Instead, we need to recognise that the person in front of us brings expertise in their own lived experience.
Partnership involves:
- shared decision-making,
- co-creating care plans,
- adapting approaches to individual needs.
The phrase “listen to me, learn from me” is not just a catch phrase, it’s a call to rebalance the relationship in the consultation room.
What this means for training us as effective, empathic pain clinicians
If these are the priorities that matter most to people with chronic pain, then we have to ask: are we training clinicians to deliver this kind of person-centred care?
Training knowledge and skills remains important, but these alone are not enough.
Our training needs to explicitly develop:
- Skills in validation and empathy
Not as soft add-ons, but as core clinical competencies. - Advanced communication abilities
Including deep listening, framing explanations (sense making), creating safe spaces for conversations, and navigating difficult conversations. - Confidence in holistic and person-centred biopsychosocial care
So clinicians can address the full complexity of chronic pain. - Capability to work in partnership
Learning how to share decisions and personalise care, rather than defaulting to one size fits all approaches, or evidence applied without consideration of the person’s context. - Support for coaching self-management
Helping patients build confidence and skills for living with pain over time, supporting people as ‘coaches’ versus ‘fixers’. - Interdisciplinary thinking
Understanding how to work both within our scopes of practice and across our professional boundaries to provide coordinated care with our colleagues.
These are the skills that patients are telling us matter most when they seek pain care.
A small but profound shift
At the point of care, this doesn’t require a complete overhaul of what we do — but it does require a shift in how we think.
Instead of asking: “How can I best treat this condition?”, we ask: “How can I best support this person?”
That question can change everything.
Because when people feel heard, respected, and involved, care becomes more meaningful, more effective, and more human.
In the end, the message for us as clinicians is clear:
If we want to improve chronic pain care, we don’t start with new techniques.
We start by learning to listen, and being willing to let what we hear reshape how we practise.
The ‘Pain Care Priorities’ framework underpins how pain training efforts are approached throughout the OPEN program, supporting clinicians to deliver care that is person-centred, integrated, holistic, coordinated, and practical.
