I have had the same pain doc for almost 13 years now. Mutual trust was established a long time ago. It does take some time. One thing that does help is that I try not to play doctor with him. I keep a pain journal and take that in each appt. He appreciates that sort of documetation. When things change and the pain gets rugged, I tell him that what WE are doing is no longer working and that I need him to reach down into his bag of tricks and please try something new. That generally gets a laugh out of him. That also elicates the desired response for me.