Repeated requests for a definitive diagnosis, prognosis, and reassurance as to the positive outcome of a therapy made by some patients with chronic pain can be very exhausting to both patient and clinician—especially when it is clear that no amount of information will be satisfactory. The practitioner can easily feel like be asked to be a psychic or fortune teller. Pain catastrophizing (PC) has emerged as critical area of study. PC has been linked pain intensity, decreased function, and treatment outcomes, including the effect of pain medications such as opioids. It is most effectively addressed by the use of cognitive-behavioral therapy procedures. Learning how to apply these strategies in the context of the typical office visit can reduce the frustration level of the clinician and patient. In more severe cases, referral to behavioral specialist may to advisable.
