Motivational interviewing for pain management

Motivational interviewing can enhance behavioural change and treatment adherence. It helps the patient to identify their own reasons for enacting change and navigate the steps involved in achieving it. The aim is to:

  • engage the patient in a collaborative therapeutic relationship
  • focus conversation on what they are wanting to change
  • evoke the patient’s reasons for wanting to enact that change (change talk)
  • help patients to plan how they will achieve their identified goals.

Motivational interviewing involves the practitioner looking for opportunities for change and asking open-ended questions rather than telling the patient what they should do. See Basic techniques of motivational interviewing for patients with pain  for basic techniques of motivational interviewing for patients with pain.

Table 1. Basic techniques of motivational interviewing for patients with pain

Technique

Desired outcomes

Example

ask open-ended questions

allows the patient to do most of the talking and the practitioner to learn about what is important to the patient (eg values and goals)

What concerns you about the amount of medicine you’re taking?

make affirmations (eg statements of appreciation or understanding, or that identify strengths or positive outcomes)

builds rapport by validating the patient during the change process

You appear to be resourceful to have coped with these difficulties for the past few years.

use reflective listening (ie paraphrase the patient’s statement to capture and check the meaning of it)

helps the patient understand their motivations, and reinforces the desire for change

So, if I’m hearing you correctly, you don’t like how your medicines make you feel but you’re scared about what will happen to the pain if you don’t take them?

summarise discussions

ensures mutual understanding, demonstrates attention to and understanding of the patient’s perspective, and highlights discrepancies between the patient’s current situation and future goals

So, if I’m hearing you correctly, you’re saying that you keep taking medicine because you’re afraid of what will happen to the pain if you stop, but the medicine doesn’t really help with the pain. Instead, what it does is make you feel awful. You know this because you’ve tried reducing your medicine before and when you did that you coped pretty well for a while and felt much better. Is that right?

Note: Adapted with permission from The Royal Australian College of General Practitioners from: Hall K, Gibbie T, Lubman DI. Motivational interviewing techniques: Facilitating behaviour change in the general practice setting. Aust Fam Physician 2012;41(9):660–67. Available at [URL]