How Can We Make the Pain Go Away? Public Policies to Manage Pain at the End of Life

Abstract

The continued undertreatment of pain at the end of life is a substantive public health problem that has not been resolved through increased public awareness, the issuance of clinical guidance for providers, or expanded organizational commitments. In this forum, we illuminate the role of public policies in promoting pain management. We review federal and state policies and consider empirical evaluations that compared the quality of state policies and the factors that contributed to their formation. We resolve that any organized interest in improving end-of-life care should begin by focusing on the development and expansion of those state policies that support the provision of evidence-based medicine for reducing the amount of pain an individual experiences at the end of life. Although empirical research is needed to determine which particular aspects of state pain policy are most critical and how these policies can be implemented most effectively, any organized effort that advances state medical board activity or another state policy would appear to be making an important step toward making the pain at the end of life go away.

Pain and Self‐Injury Ideation in Elderly Men and Women Receiving Home Care

“…Prior research has reported that undertreatment of pain is pervasive in older persons20 and that those who are older, minority, or cognitively impaired are more likely to receive unsatisfactory analgesia 21,22. While interventions at multiple levels are needed, public policies could play a role in improving pain management 20. Many of the states' drug prescribing laws, regulations and medical board guidelines have been criticized as outdated 23.…”

Promoting a “Good Death”: Determinants of Pain-Management Policies in the United States

“…Imhof and Kaskie (2007) confirmed that state governments assume broad authority over matters concerning pain management at the EOL. All fifty state legislatures have adopted a version of the federal CSA to establish an intrastate legal structure to control drugs with abusive potential (Joranson and Gilson 2003).…”

“…Several state legislatures also have adopted intractable pain treatment acts (IPTAs) intended to address physician fears of regulatory scrutiny, and thereby ensure that patients who suffer at the EOL would not be denied opioids for pain relief (Joranson 1995; PPSG 2000). Moreover, Imhof and Kaskie (2007) report that state courts are increasingly more involved in promoting pain-management policy by handing down rulings concerning the undertreatment of pain at the EOL. For example, a California court recently held a physician liable for the inadequate treatment of pain according to current medical standards and awarded $1.5 million to the family of an elderly man who suffered intolerable pain right before his death (Compassion in Dying Federation 2005), and a nursing home in North Carolina was held liable for providing inadequate pain control to its residents (McIntire 2003).…”

“…Twenty-two states have established task forces to study pain and other EOL issues (National Conference of State Legislatures 1999–2003), and the National Association of State Attorneys General recently passed a resolution calling for improved pain policies (Edmondson 2006). Notwithstanding this wide range of state activity, Imhof and Kaskie (2007) conclude that primary public responsibility for development and oversight of EOL pain policy was assumed by state medical boards.…”

Dying in a rural residential aged care facility: An action research and reflection project to improve end‐of‐life care to residents with a non‐malignant disease

“…shows that this is a common problem in other agencies (McClean & Higginbotham, 2002;Imhof & Kaskie, 2008). Therefore, the implications for symptom management generated by the participants within their workplaces are potentially instructive for staff working on other agencies, with whom these implications resonate.…”