The GP adopts a strategic approach to the patient on long term pain relief, first broaching the non-pharmaceutical topics of Physiotherapy and Acupuncture, contrasting these with the potential harms of the pharmaceutical side effects on daily functioning. 

He considers the principle of limited impact of dose increases on the pain alongside the risk of escalating side effects. 

He very successfully uses the language of Shared Decision Making here: 'Work with me' 'We can think about...' 'What I might propose' 'Maybe make a bit of a plan' and 'take things a small step at a time' while expressing this in a tone that is approachable and suggestive rather than directive

This comes across as a reasonable professional happy to engage the patient, rather than (if you'll pardon the pun) prescriptive in their approach to the patient's pain control. 

He demonstrates his appreciation of the patient's self-employed status and the time commitment required for Physiotherapy- through this explanation the patient can consider the practicality of the initial session followed by work on the exercises in his own time 'to get more movement back' This shows tailoring of the management for the individual and that's what makes a successful consultation- knowing the evidence-based interventions and then suggesting a choice that works best for the patient. 

All Wales Deprescribing Guidance is a helpful document to consider strategies for particular medication groups.