Toward Fair and Humane Pain Policy

Abstract

Pain policy is not drug policy. If society wants to improve the lives of people in pain and compress the terrible inequalities in its diagnosis and treatment, we have to tailor policy to the root causes driving our problems in treating pain humanely and equitably. In the United States, we do not. Instead, we have proceeded to conflate drug policy with pain policy, relying on arguably magical thinking for the conclusion that by addressing the drug overdose crisis, we are simultaneously addressing the pain crisis. This is a category error, decades of commitment to which have resulted mostly in a worsening of both public health problems. Disentangling our problems in treating pain fairly and equitably from our problems with drugs and substance use is the only path to humane and ethical policy for each.

‘First Do No Harm’: physician discretion, racial disparities and opioid treatment agreements

“…One side effect of the opioid crisis is that patients with chronic pain have increasingly had difficulty finding physicians willing to treat them. 41 Once patients with chronic pain have found a physician, it could be a source of comfort for them if their OTA suggests that they will not be dismissed from the practice just because the physician sees no clinical improvement. Moreover, this clause seems precisely like the sort of domain in which physician discretion is key: physicians should use their clinical judgment to determine whether opioid medications are working to ensure that patients do not become dependent on a non-beneficial drug.…”

Persistent Spinal Pain Syndrome: New Terminology for a New Era

“…Progressively, it is apparent that patients with nonspecific back and other types of chronic pain are stigmatized and marginalized. [4][5][6] Compounding matters, it has been argued that this stigmatization and marginalization has likely been exacerbated by the ongoing COVID-19 crisis. 7 The impact of stigmatization and marginalization of these unfortunate patients has been devastating, including the deterioration of pain sufferers' trust in health care professionals, 8 quality of the pain care that patients receive, 9 perceived injustice (which has recently been empirically related to greater pain severity and increased functional impairment), 10 and exacerbated psychological distress 11 including increased depression and anxiety.…”