Toward a more empathic relationship in pain medicine.

Specialists in pain medicine commonly experience psychological assaults on their self-esteem, especially from patients who seem unreasonably demanding, overly critical, or threatening. This article will discuss how these challenges can trigger a professional's self-protective and defensive coping mechanisms that, in turn, can provoke decidedly unempathic responses. Situations that compromise empathy, however, can be particularly worrisome in health delivery practices like pain medicine that are highly relational and that seek to use relationships therapeutically. The article will therefore conclude with two sets of strategies that might be useful in managing these uncomfortable situations more empathically. The first set will focus on certain pragmatics of empathy skill development. The second will discuss the Eastern notion of "bare attention" as an ideal form of empathic engagement that can also counteract an unhealthy degree of defensiveness when self-esteem is threatened.