When the scan does not explain the pain and helping patients understand what comes next – GIRFT Guidance

For orthopaedic surgeons, some of the most challenging consultations are not about making a structural diagnosis, but about what to say when investigations are reassuring, surgery is not indicated, or pain persists despite technically successful treatment. Without a clear and credible explanation, patients can be left fearful and uncertain, sometimes leading to repeated investigations, referrals and treatments that are unlikely to help.

As introduced by Dr Helen Makins, GIRFT national clinical lead for chronic pain, during the plenary at the BOA congress, a new handbook has now launched. What Matters to Patients: A GIRFT Handbook for Chronic Pain Conversations, provides practical support for these consultations. Developed with people with lived experience and clinical experts, it offers simple explanations, suggested language and practical approaches to help clinicians validate pain, explain why pain and structural findings do not always correlate, and give patients a positive and evidence-based direction forward.

For busy orthopaedic practice, its message is simple: what we say is part of treatment. A clear explanation can reduce fear, restore trust and help patients move from searching for structural answers towards recovery and self-management.

Read and download the GIRFT chronic pain handbook

Watch the presentation from the BOA Congress 2026 below: