Constructions of chronic pain in doctor-patient relationships: bridging the communication chasm.

This study examined interactions between doctors and their chronic pain patients in the context of investigations for medically unexplained pain. Doctor-patient interactions were explored through the analysis of the accounts of the communication process in the chronic pain consultation of 20 chronic pain patients with their pain specialists and the accounts of 22 pain specialists with their chronic pain patients. An implicit dialogue between doctors and their patients was identified that appeared to undermine the quality of their interactions, challenged each other's credibility and caused distress to both parties. The implicit dialogue of the chronic pain patient was based on the biogenic theory while the implicit dialogue of doctors was underpinned by psychogenic theory. Potentially healing interactions between doctors and their patients that do not rely on the biogenic model of the visible body or the psychogenic model of invisible pain are needed to assist the communication between chronic pain patients and their doctors. A systemic theoretical analysis of this process is offered.