Patients in pain

How treatment plan formulations shape patient response


  • Stefan Timmermans University of California, Los Angeles
  • Tanya Stivers University of California, Los Angeles
  • Keith Cox University of California, Los Angeles
  • Amanda McArthur Johns Hopkins School of Medicine



conversation analysis, doctor-patient communication, opioids, social interaction, treatment negotiation


Communication research on medical interaction has made inroads into how patients shape treatment outcomes as well as how physician presentation of treatment can shape patient acceptance or resistance. Pain is the number one reason patients visit primary care physicians. The overprescription of opioids for chronic pain remains a major public health problem in the US and constitutes a risk factor for opioid addiction. In this study, we investigated how primary care physicians communicate recommendations for alternatives to opioid treatments for patients with self-reported moderate to serious chronic musculoskeletal pain and examined the relationship between communication strategies and patient resistance to non-opioid treatment recommendations. We relied on a convenience sample of 35 video recorded visits in which musculoskeletal pain was reported as moderate to severe (or over 5 on the pain scale). Using a combined approach of abductive analysis, conversation analysis and descriptive statistics, we show that physicians are less likely to face patient resistance when they frame their non-opioid pain treatment recommendation as novel and present the treatment as concrete and tailored to the patient’s problem.

Author Biographies

  • Stefan Timmermans, University of California, Los Angeles

    Stefan Timmermans is a Professor of Sociology at the University of California, Los Angeles. He has conducted research on medical technologies, health professions, death and dying and population health. He is the author of Data Analysis in Qualitative Research: Theorizing with Abductive Analysis (with Iddo Tavory, University of Chicago Press, 2022).

  • Tanya Stivers, University of California, Los Angeles

    Tanya Stivers is a Professor of Sociology at the University of California, Los Angeles. She is a conversation analyst with an interest in social interaction in ordinary family interaction and pediatric and family healthcare contexts. She is the author of The Book of Answers: Alignment, Autonomy and Affiliation in Social Interaction (Oxford University Press, 2022).

  • Keith Cox, University of California, Los Angeles

    Keith Cox is a PhD candidate in the Department of Sociology at University of California, Los Angeles. He is a conversation analyst with an interest in pediatrics and neurology.

  • Amanda McArthur, Johns Hopkins School of Medicine

    Amanda McArthur received her PhD in conversation analysis and medical sociology from UCLA and is currently a postdoctoral research fellow in the Johns Hopkins School of Medicine. She has conducted research on clinician–patient communication, including talk about pain and diagnosis in primary care and conversations about medication non-adherence in HIV specialty care.


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How to Cite

Timmermans, S., Stivers, T., Cox, K., & McArthur, A. (2024). Patients in pain: How treatment plan formulations shape patient response. Communication and Medicine, 19(2), 137-151.