Empathy is a huge part of communicating about pain successfully, said Berry. “Just letting patients know you hear them is going to help. It can defuse the situation and take your own anxiety down as well.”

One way to tap into empathy is to ask questions, said McPherson. “People in pain are happy to tell you about it. When talking about medications, I like the Dr. Phil approach. I ask, ‘How’s that working for you?’ It’s not accusing.”

Berry came to believe in the power of validation after witnessing a colleague address a patient with residual postoperative pain. “He sat down at the same level as the patient, face to face, and said, ‘You must be in a tremendous amount of pain.’ The patient stopped, teared up, and thanked him.”

Berry added that patients who are drug-seeking often don’t respond to validation. “They would keep asking for medication and keep saying they’re in pain. When you attempt to validate someone’s feelings, if the pain is real you’re probably going to stop them in their tracks.”

When patients answer questions, their delivery is as important as the words they use, said McPherson. She suggests pharmacists ask about the “three Ps”: precipitating, palliating, and previous treatments.

“What causes the pain? What nondrug solutions relieve the pain? What other treatments has the patient tried? They should be able to answer those questions without hesitation,” McPherson said. “If they look like they don’t know what you’re talking about, that’s not a good sign.”

Pharmacists should be careful about tossing off advice, said Berry. “The patient has probably heard a million different things they can do for pain. Say you’ve noticed their medication doesn’t seem to be working, and ask if recommendations would be helpful, instead of giving information they may have already heard.”

If pharmacists suspect drug-seeking, the tough questions should be couched in terms of trying to understand the patient, McPherson added. “You could say you’ve noticed the patient is always early to fill the opioid prescription but never fills the Lyrica prescription, and ask why. There could be a legitimate reason, like a patient thinking they’re allergic to a medication when really the dose is too much.”

Even when suspicion runs high, it’s best to make the process about the patient’s health, McPherson said. “Don’t say, ‘I think you’re addicted.’ Instead, say something like, ‘Generally this medication is not used for years. I would like to discuss this with your doctor to make sure we’re doing the best job we can for you.’

“Be vigilant, because it’s our responsibility to protect patients and society by not dispensing something inappropriate, but don’t go overboard,” McPherson added. “It’s [hard] to be a legitimate pain patient today. Explore all the avenues.”