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Dealing With Difficult Patients in Your Pain Practice
  1. Ajay D. Wasan, M.D., M.Sc.,
  2. Joshua Wootton, M.Div., Ph.D. and
  3. Robert N. Jamison, Ph.D.
  1. Departments of Anesthesiology, Perioperative and Pain Medicine
  2. Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
  3. Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  1. Reprint requests: Robert N. Jamison, Ph.D., Pain Management Center, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail: Jamison{at}


Pain patients can be difficult. They can provoke negative feelings of frustration and anger among clinicians and damage the doctor-patient relationship. This article helps practitioners to identify those pain patients who would be prone to difficult behavior and sheds light on some of the reasons behind the behavior that give rise to difficult feelings. Issues of comorbid psychopathology, hostility, suicidality, aberrant drug behavior, and chronic noncompliance are discussed. Specific recommendations are also given of the best ways to manage patients with difficult behavior.

  • Difficult patients
  • Doctor-patient relationships
  • Psychiatric comorbidity
  • Hostility
  • Suicidal behavior
  • Substance abuse

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  • A portion of this manuscript was presented at the American Society of Regional Anesthesia Fall Pain Meeting, San Diego, CA, November 15, 2003.