Enacting Epistemic Justice to Promote Safer Care for People Living with Chronic Pain : A Clinician's Guide to Action.

Background People living with chronic pain frequently encounter invalidation, including epistemic injustices that erode trust in healthcare. Objective To translate philosophical and empirical insights regarding epistemic (in)justice into concrete, clinician-focused practices. Methods Evidence was synthesized from a prior systematic review and narrative interviews with seventeen adults living with chronic pain in Québec, Canada, and analysed using reflexive thematic analysis. Results A clinician-centred practice framework is presented, including: (1) Virtuous approaches-listening, validation, generosity, vulnerability, humility, and solidarity; (2) Narrative approaches-protecting story space, engaging in metaphors/counterstories, etc.; (3) Cognitive strategies-mindfulness and epistemic repair; (4) Patient partnership-inviting agendas, integrating patient-generated data and knowledge, and shared decision-making; and (5) Clinician support for patients' resistance strategies and (6) structural change. Each domain includes reflective questions and concrete actions (e.g., explicit validation statements, protected time for complex narratives, transparent acknowledgement of uncertainty, etc.). Participants' testimonies illustrate how these practices have the potential to counter testimonial and hermeneutical injustices, strengthen the therapeutic alliance, and enhance perceived safety. Conclusion Epistemic justice is an ethical and clinical imperative. Although guidance in this article targets clinicians, durable impact requires organizational commitments and active patient engagement to embed these practices in everyday care.