Management of Pain in the United States—A Brief History and Implications for the Opioid Epidemic

Abstract

Pain management in the United States reflects attitudes to those in pain. Increased numbers of disabled veterans in the 1940s to 1960s led to an increased focus on pain and its treatment. The view of the person in pain has moved back and forth between a physiological construct to an individual with pain where perception may be related to social, emotional, and cultural factors. Conceptually, pain has both a medical basis and a political context, moving between, for example, objective evidence of disability due to pain and subjective concerns of malingering. In the 20th century, pain management became predominately pharmacologic. Perceptions of undertreatment led to increased use of opioids, at first for those with cancer-related pain and then later for noncancer pain without the multidimensional care that was intended. The increased use was related to exaggerated claims in the medical literature and by the pharmaceutical industry, of a lack of addiction in the setting of noncancer pain for these medications—a claim that was subsequently found to be false and deliberatively deceptive; an epidemic of opioid prescribing began in the 1990s. An alarming rise in deaths due to opioids has led to several efforts to decrease use, both in patients with noncancer conditions and in those with cancer and survivors of cancer.

Primer on adult patient satisfaction in perioperative settings

“…For instance, to minimize post-operative pain, pain relief may be achieved by overprescribing opioids. These well-intended actions contribute to opioid addiction, death from opioid overdose, and ultimately our current opioid epidemic (Bernard et al, 2018).…”

Where We Come From and Are We Aware of Where We Are Going To?

“…Opioids have become a common treatment strategy, available to the patients by means apart from doctor's prescriptions [59][60][61]. As a result, the morphine consumption per person has been increasing in the latest years [62] to reach what has been named an opioid epidemic [46,[63][64][65][66][67]. Sometimes the process starts after the prescription of opioids to treat acute pain, for example, after a surgical procedure, but patients get addicted to the drug, and then it becomes difficult to make them abandon their use [68][69][70][71][72].…”

Low Dose Ketamine Used for Acute Pain Management in the Emergency Department

“…The treatment of pain has been focused on pharmacological interventions based on subjective data for the past 2 decades [14]. Furthermore, the pharmaceutical industry has been indicted in the falsification of studies completed for opioid medications in order to persuade and influence prescribers to write for opioids at higher doses and frequencies.…”

“…Furthermore, the pharmaceutical industry has been indicted in the falsification of studies completed for opioid medications in order to persuade and influence prescribers to write for opioids at higher doses and frequencies. Congressional hearings started in 2018 have addressed big pharmaceutical companies such as Perdue Pharma and pursued criminal charges against them [14]. After years of litigation, the Stackler family, owners of Purdue Pharmaceuticals were mandated to pay 3 billion dollars total in damages.…”

“…Non-severe adverse effects that need to be monitored and treated due to low dose ketamine include nausea, dizziness, drowsiness, vomiting, decreased oxygen saturation [19] [28]. Opioids such as morphine also have similar non-severe adverse effects [19] [28], but their use also worsens the opioid epidemic [2] [14].…”