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Bob Large
The Auckland Regional Pain Service, Auckland District Health Board, Auckland, New Zealand

Pain is disturbing. It upsets the patient. It upsets the clinician. Hence we strive to relieve pain and expect gratitude in return. Yet people in pain have a reputation for being "difficult". Pain changes normally rational people into demanding, irrational supplicants. Often there is no meeting of minds. Especially when the relief we offer, and even promise, is not forthcoming. People with chronic pain have had many promises and disappointments in their journey from acute to chronic pain. Failure is in the air.

Failed therapy upsets the patient. It upsets the clinician. Yet we pay little attention to the ingredients of failure. Indeed we often seem to invite failure by our words and actions. We may invalidate the patient's experience, practise premature confrontation and keep rapport as shallow as possible, thus ensuring the patient is unlikely to return. We may take the role of a rescuer, encourage unrealistic expectations and undermine self-efficacy, thus setting up failure whilst holding the patient in therapy for the medium to long term.

Our current state is one where we have a plethora of treatment options with scant evidence for efficacy. Yet we argue amongst ourselves about the virtues of treating the mind as opposed to nerves. We have a shared vision of interdisciplinary collaboration for the good of the patient. Yet interdisciplinary work is harder than we ever imagined and is unlikely to get any easier until we face our fears and rationalisations around failure.

Time of Presentation
Saturday 1 May 2004 - 1030-1200