When someone wants a pain medicine you know they should not have, how do you lead them if you don't have a trusting relationship.

Pain management: Pain management with use of opioids required strict compliance. Prior records of other providers who have provided opiods is a must. In addition, patients should be offered a multidisciplinary approach for handling their pain- including rehabilitation, psychotherapy (if needed), injections, consultations with other specialties if warranted. Demonstration of compliance with treatment plans is a mus.

Pain control: More often than not, our role as physicians is that of educator. So, try to educate the patient as to alternatives. Failing that, act as coach encouraging the patient as to non-addictive and arguably safer alternatives, including non-drug options. Lastly, we sometime need to "just say no". Having said all that, one presumes that the underlying cause of the pain is being properly addressed.

Pain treatment: Often, people come to pain specialist for consultation. They come in for your opinion regarding their conditions. If you don't feel comfortable to offer certain therapy, you shouldn't feel obligated to do it. You should educate patients about their conditions and your recommendations to treat it. At the end of the day, you're the doctor, not them.