“I know I can’t take the pain away. I just don’t know what to do to help.”

That’s what partners of people living with chronic pain tell clinicians constantly, and for decades, pain medicine gave them the wrong answer.

From the 1970s, pain programs coached partners to withhold eye contact when patients grimaced, and reward “well behaviour” instead: look away, wait it out. It turns out to be largely wrong. Recent reviews find no consistent link between a warm, attentive partner and worse pain outcomes. What predicts poor outcomes is criticism, dismissiveness and being told to distract yourself.

That reversal was the headline from Professor Toby Newton-John’s Australian Pain Society (APS) webinar in August, and it has direct implications for how GPs handle the person who so often comes to the appointment too: the partner.

Why the partner is already in the room

Pain is rarely a solo experience. In lab studies, simply having another person present, or even just a photo of a partner, measurably increases pain tolerance. In a large US survey published this year, 4.4% of adults said chronic pain affects their family “most days or every day.”

Beyond the physiology, chronic pain reshapes households: someone else picks up domestic tasks, attends appointments, absorbs lost income. Relationships shift too — from partnership toward caregiving, with less intimacy and, sometimes, unexpected closeness that can undercut a patient’s independence. A large Australian review published this year concluded that the type of support a partner provides, not just how much, explains much of the difference in patient outcomes, and recommended couple dynamics become a routine part of clinical assessment. Whether or not a GP asks about any of this, it’s already shaping adherence, mood and how well gains from treatment hold once a program ends.

Ask, don’t assume

Professor Newton-John uses four questions at assessment that translate directly into a GP consult, and take under two minutes. These questions to the patient help to unpack how their partner (or whoever they live with or rely on most) responds when they are in pain:

1. Can your partner tell when your pain is bad — and if so, how?
2. What do they typically do about it?
3. How does that response sit with you?
4. Would you prefer they did something different?

 
The aim is to understand the patient’s experience of the people around them, not to assess or judge the partner. Most people living with pain don’t want to be rescued or ignored. They want to be believed and encouraged.

Validation beats reassurance

What the person in pain is usually looking for is validation: acknowledgement that their pain is real and hard. The most useful shift involves helping partners move from managing behaviour to validating their partner’s experience, Professor Newton-John says.

• “You’re always complaining” becomes “I can see this is hard — what would help most right now?”
• “Stop, you’ll flare up your pain” becomes “What’s the smallest version of that activity you could manage?”
• “Let me do it, it’ll be quicker” becomes “What can I do to help you with that?”

GPs can give that advice to the partner directly if they attend the consult, or pass it on through the patient.

The partner’s own load

Partners commonly carry guilt, helplessness, disrupted sleep and their own untreated pain or low mood, and they rarely raise it unprompted. Pain in the partner often goes unrecognised. Where the relationship looks strained, a referral to counselling is best raised gently later in another consultation, not when they come in expecting a pain review.
None of this turns a chronic pain review into couples counselling. It’s a few extra minutes of structured curiosity with the patient’s consent.

The bottom line

Chronic pain is never really a one-person problem. Newton-John’s four questions, paired with a little validation, take two minutes and can do more for a couple than another referral. Try them at your next chronic pain review, with both people in the room, and see what it opens up.

Continue Learning with the Australian Pain Society

Professor Newton-John’s webinar highlights how understanding relationships and everyday circumstances can inform pain care.
The Australian Pain Society brings together healthcare professionals, researchers and educators from different disciplines to deepen understanding of pain and its management. Its webinar series explores clinically relevant topics and perspectives that GPs can bring into everyday practice.

For GPs wanting to strengthen their pain care skills and connect with colleagues across disciplines, APS membership offers a way to become part of that learning community.

Explore APS education and find out how to become a member.