Pain is rarely “just physical.” It weaves into patients’ work, relationships, sleep, mood, and identity. And while clinicians often focus attention on clinical protocols and medication titration, patients may be wondering: “Will I be able to walk the dog again?” or “When can I return to gardening?”
A shared pain management plan bridges this gap. It shifts care from a prescriptive, plan approach to a collaborative, patient-centred roadmap. When done well, it empowers patients, improves adherence, and leads to more meaningful functional outcomes.
Why Shared Plans Matter
Patients with chronic or persistent pain may feel like passengers on a treatment train they didn’t choose. They may have seen multiple providers, tried countless medications, and sometimes undergone surgeries they don’t fully understand, all with limited relief. By co-creating a plan, we:
- Validate their own real world
- Build trust and engagement
- Set realistic expectations
- Improve function and quality of life, not just pain scores
Evidence shows that patient-centred goal setting enhances motivation, reduces fear-avoidance behaviours, and supports self-efficacy — all critical for chronic pain care.
Key Elements of a Shared Pain Management Plan
1. Identify What Matters Most
“What would you like to be able to do that you can’t do now?”
“What activities are most important to you?”
Avoid centering patients’ focus solely on “cure from pain.” For most patients, function and participation matter more than absolute pain elimination.
2. Educate About Pain Mechanisms
Briefly explain pain neuroscience, including concepts like central sensitisation and nervous system hypersensitivity. This reframes pain as a system issue, not just tissue damage.
Example phrasing:
“Think of your pain system as an overly sensitive alarm. Our plan will focus on calming that alarm and helping you get back to the activities you value.”
3. Set Functional, Realistic Goals
Examples include:
- Walking 10 minutes without needing to rest
- Returning to part-time work
- Cooking dinner without flaring up
- Playing with children / grandchildren
Goals should be specific, measurable, and meaningful.
4. Outline Multimodal Strategies
A shared plan integrates:
- Physical strategies: Graded activity, pacing, tailored physiotherapy
- Psychological strategies: pain coping skills, relaxation and mindfulness
- Pharmacological strategies: Judicious use of medications, often as a supportive, not central component
- Lifestyle strategies: Sleep hygiene, nutrition, stress management
- Interventional pain procedures or surgery when indicated
The Importance of Pacing and Graded Exposure
Help patients understand the principle of pacing: balancing activity and rest to avoid boom-bust cycles. Similarly, graded exposure gently reintroduces feared or avoided activities, breaking the cycle of avoidance and deconditioning.
Addressing Setbacks
Discuss setbacks before they happen. Pain flares are normal and do not mean damage. Build a “flare-up plan” together so patients feel prepared rather than defeated when setbacks occur.
Example: “A flare doesn’t mean failure or harm. A pre-planned strategy is a pathway to manage pain and get back on track.”
Checking in and Reviewing
Shared plans are living documents. Schedule regular reviews to celebrate wins, adjust goals, and pivot strategies as needed.
Suggested questions to ask in reviews:
- “What’s going well?”
- “What’s been harder than expected?”
- “Do these goals still feel right for you?”
Practical Tips
- Use simple language and metaphors — avoid jargon.
- Encourage the patient to write down or keep a copy of the plan.
- Involve family or support people when appropriate.
- Reiterate the shift from “fixing” to “functioning.”
- Collaborate regularly with the core team to reinforce consistent messaging.
Creating a shared pain management plan isn’t about handing over a to-do list. It’s about partnering patients to craft a roadmap that reflects values and life goals, not just a pain score.
When patients are empowered as active participants — rather than passive recipients — they’re more likely to engage, persist, and ultimately find a way forward, even in the presence of ongoing pain.
