Without doubt, the sole responsibility for pain management resides with the patient. Period.
We have a pattern of patients seeking a passive role with both acute and chronic pain. They dependently allow others to prescribe, inject, insert, implant and direct.
They do not improve, and they become depressed.
A cornerstone of depression is a misperceived total helplessness. As long as the patient assumes no role in rehabilitation and becomes a passive entity, they will not improve, they will become depressed, their pain will worsen, and they do become chronic.
The most direct solution is to determine the degree of responsibility the patient is being directed to assume by the primary treating physician. If office visits are brief _how has your pain been? Here are your refills. See you in two months,_ the patient will return home, flop on the couch, nap, watch TV, overly utilize their medication, gain weight, and engage in no meaningful daily activities.
Someone must insist that the patient understands that any improvement rests largely upon their willingness to consistently engage in some meaningful activity to add structure to their days and some degree of distraction from pain. Families also have to be cautioned against two extremes: a. smothering the patient with nonproductive sympathy, or b. ridiculing and cajoling the patient for he/her complaints.
Passing the patient between and among providers has never shown a positive pattern of change.