OBJECTIVE: The study sought to elucidate and refine the interpersonal, communicative dimension of the communal coping model (CCM) of catastrophizing. The primary aim was twofold. First, we examined the relations among pain intensity, catastrophizing, and pain behaviors as they function within the patient-health provider relationship. Second, we investigated the role of catastrophizing and pain behaviors in potentially influencing patient satisfaction with the provider, provider attitudes, and provider behavior. Mediation models were examined. DESIGN: The study was cross-sectional design with repeated measures. SETTING: This study was conducted at a university-based family medicine clinic and a private practice rheumatology clinic. Nineteen health providers and 49 chronic pain patients receiving treatment in a medical setting completed the study. OUTCOME MEASURES: Patient outcome measures included pain intensity, catastrophizing, pain behaviors, and patient satisfaction with the provider. Health provider outcome measures were an assessment of provider attitudes and length of medical exam. RESULTS: The patient's level of catastrophizing entering the medical exam significantly predicted the interactive dynamics between the patient and the health provider during the exam and patient satisfaction after the exam. The patient's perceptions of pain and catastrophic thought processes may be interpersonally expressed to health providers via exaggerated pain behaviors. CONCLUSIONS: Current findings indicate suggestions for refining the CCM. Results suggest that alleviation of catastrophic cognitions may facilitate more effective interpersonal communication within the patient-health provider relationship. Identification of those factors that improve patient-provider dynamics has important implications for the advancement of treatment for chronic pain and reducing the costs associated with persistent pain.