Pain, Ethics, and Public Policy

Abstract

Pain Medicine is a journal that has, perhaps more than any other, affirmed the significance and relevance of ethical principles and analysis to competent and compassionate pain relief in clinical practice. It is the only medical journal with a section specifically devoted to ethical issues in pain management. Consequently, we are pleased to be able to include in this issue of the journal an analysis of preliminary data from “The Pain Action Initiative: A National Strategy (PAINS),” a project undertaken by staff members of the Center for Practical Bioethics with support from the Lance Armstrong Foundation, Rx Action Alliance, and Purdue Pharmaceuticals. The article “Defining the Landscape for Chronic Pain Ethics” is for the most part a comprehensive list of what is wrong with pain care, research, and education. The issues raised are not all normative, but rather encompass political, social, and economic factors that have a negative impact on the quality and accessibility of pain care. Nevertheless, the report does provide the background conditions upon which to ground further development and articulation of the ethical issues. As the authors note, remarkably, despite the pervasive perception among these focus groups that ethical issues permeate the range of concerns on chronic pain relief, there is a dearth of articles in the clinical literature on the ethics of pain management—249 in a recent PubMed search, and only 75 when palliative care and basic neuroscience are excluded. It is even more surprising, but worth noting …