As adult children, we are watching our parents struggle through Dad's new diagnosis of osteoarthritis. He seems to be in a lot of pain but unwilling to say so. Mom seems to be unaware (insensitive?) to his needs. Should we say something? And if so, what?

There are many new challenges for partners facing the prospect of a chronic, painful condition such as osteoarthritis. One of the biggest stumbling blocks is communication. Patients may not feel confident in their ability to explain their pain or other symptoms. Partners may overestimate, underestimate, or misunderstand their spouse's pain, distress, and level of disability.

There has been some suggestion that treatment intervention for rheumatology patients include training in the area of effective communication. Each member of the couple must feel confident and comfortable expressing his or her concerns. The communication process must be open and nonjudgmental with listening and acceptance of each person's thoughts, feelings, and experiences.

Communication skills training can help reduce distress between partners. It can also help the partner become more supportive and better able to assist the patient during painful episodes. Since there is often a tendency to hold back in starting conversations, such training could provide couples with the opportunity to grow in this area.

With any new diagnosis, there's a certain period of adjustment that takes place. Give your parents a few weeks (to months) to sort things out on their own. If you still have concerns, suggest contact with a social worker or counselor. Even one or two sessions of counseling can help improve communication, potentially improving patient outcomes as well. With a little outside help, your father may feel better mentally and physically.