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1. Establish clearly the purpose of the referral. Help the patient understand that the goal of the evaluation sequence is to establish what is wrong and what is not wrong.
2. Do not challenge the authenticity of the pain. Rather, give the patient some liberty in describing the symptoms. Bear in mind that negative laboratory results do not mean that pain is absent or all psychological, because the studies cannot show or prove the cause or the intensity of the pain in all cases.
3. Decrease the frequency and/or the intensity of the pain based upon mechanism-specific treatment, help the patient cope with pain that's slower to resolve, increase the patient's quality of life, increase the patient's ability to function, and decrease the costs to as well as the demands on the entire health care system.
4. Patients must be active in choosing the treatments utilized, based upon informed consent. They must be active participants in the management program. They are free to choose or not choose any of the treatments offered, but they cannot make their decisions the clinician's problem by continuing to demand pain relief.
5. Do not make the treatment worse than the primary disease. Be attuned to the immediate and the delayed side effects and complications of all treatments chosen. Worse than a real complication may be a perceived one, made all the more grievous by an unreceptive, unavailable clinician who projects a defensive, blameless attitude.
6. The more complex or highly technical the treatment provided, the more the clinician will be expected to be readily available to manage any and all issues that arise. The intensity of this necessary follow-up should be a factor in providing such therapy.
7. Change only one treatment at a time in the patient's therapeutic program to create, ultimately, the most effective treatment program. Just taking the pain away will not instantly eliminate all of the associated psychosocial consequences of that pain in the patient's life.