Principles & Practice of Pain Medicine > Part III. Psychological Evaluation and Treatment of Chronic Pain > Chapter 15. Consulting on the Difficult Patient in Pain Scott M. Fishman

Consulting on the Difficult Patient in Pain

"Treating pain in a difficult patient may raise the challenge and lower the expectations from any analgesic intervention. In this section, the term difficult is applied to patients with behaviors, rather than symptoms, that are beyond the norm and that undermine treatment. Discussion of other difficult symptom presentations is beyond the scope of this chapter. Difficult patients who are in pain often are in conflict about whether or not they want care, want the care they are offered, or want pain. Groves has said, "Such patients simultaneously demand and reject care." These patients may also simultaneously obtain and undermine treatment or flatter and frustrate their clinicians. In mild cases, they may strike a cord of uneasiness in their caregivers. In severe cases, caregivers may experience strong emotions such as fear and hate...."