Helping Patients in Pain: Creating Agency Without Blame

The best way to get someone to stop listening to you is to blame them for a problem. Anyone experiencing chronic pain has no doubt felt this sense of blame from healthcare providers as well as friends and family (not all, but most likely some of these individuals). As I’ve written about before, others’ reactions to a person in pain or with a disability are not always helpful and can in fact be incredibly hurtful or misplaced (See: “HOW PEOPLE REACT TO DISABILITY”).

One of the great challenges in having chronic pain or working with patients with chronic pain as a healthcare provider is to embrace a perspective that empowers the patient but at the same time is realistic. As physical therapist Jeff Moore reinforces on the podcast PAIN REFRAMED, the goal is to provide a hopeful and optimistic message, yet a realistic one. I think of this as communicating the idea that: “you can improve!” But also acknowledging the reality of: “it probably has taken a long time to develop chronic pain (you’ve had this problem for a while), so it may take a while to see significant improvement.”

With a similar theme, it does no good as a patient or someone in pain to blame healthcare providers or the healthcare system as a whole (though there are definite flaws and shortcomings to be sure). I would bet the majority of doctors, nurses, physical therapists and all the other healthcare professionals who take on the job of supporting others’ pursuit of health, have altruistic intentions and do the best that they can with the knowledge and resources that each of them possess at that moment. And still…people make mistakes, communicate misinformation, perform their jobs poorly sometimes. Still, we have this enormously prevalent burden of chronic pain sufferers in the U.S. (approximately 1/3 of the population will experience chronic pain!3) and the world1,2,3…what to do about it?

One solution as I see it is to promote the message of agency without blame. What does that mean? Agency refers to the ability of an individual to act with free-will and autonomy. The idea of creating agency is to empower another person so that they feel able to change/grow/move in different ways than they otherwise have experienced. There is a delicate way to communicate this to be sure. It takes incredible effort to communicate the empathy necessary to develop the trust needed to promote behavior change in someone with chronic pain.

Part of the message to those in pain should be this:

“Your Pain is NOT Your Fault”

and at the same time, this:

“You DO have the power to take action to improve your pain experience”

This is agency without blame.

For more on this topic, check out my interview on the Pain Reframed Podcast:

Pain Reframed: Episode 72: Moments From a Year of Healing | Leda McDaniel


  1. Buchbinder R, van Tulder M, Öberg B, et al. Low back pain: a call for action. The Lancet. 2018;391(10137):2384-2388.
  2. Fayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open. 2016;6(6)
  3. Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The Prevalence of Chronic Pain in United States Adults: Results of an Internet-Based Survey. The Journal of Pain. 2010;11(11):1230-1239.

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