On the Transformation of the “Profession” of Pain Medicine to the “Business” of Pain Medicine: An Introduction to a Special Series

Abstract

Over recent years, considerable concern has been expressed regarding the quality of pain treatment in the United States; the deterioration of which has led to the discipline as being described as in a state of “crisis”[1–3]. Our current treatment of pain is not particularly effective, resulting in a lack of improvement of quality of life among treated pain sufferers—irrespective of the increasing number and costs of treatments that are being received [4]. A number of theorists [5–8] have suggested that much of this crisis can be explained by the deepening and widening schism between the various stakeholders involved in pain care, with these stakeholders including patients, pain care professionals, hospitals, third-party payers, employers, industry (defined broadly), pain educators and societies, legislatures, and various government agencies. Hamaty [9] has described today's physician as a “lesser professional,” a “reluctant entrepreneur,” part of an immoral society. While some in the pain community maintain hope that broad health care reform will result in an improvement in the quality of care provided to patients with pain [10], the scope and impact of these efforts are still of unknown quantities [11]. Medicine as a profession , including pain medicine, has evolved in myriad ways over the past century. Some have dated medical professionalism back to the Hippocratic era [12], while others in the Renaissance, when the notion of a social obligation to treat the sick developed [13]. However, it was not until the mid-19th century that the American Medical Association (AMA) developed the first national set of ethical and practice standards [14], and one can accordingly identify 1847 as the birth date of the profession of medicine in the United States. Physicians are obligated to adhere to the (updated) AMA ethical standards, just as nurses, psychologists, physical therapists, …