Posted: August 31st, 2022

Emerging Ethical Problems in Pain Management

Emerging Ethical Problems in Pain Management
Effective pain management is a vital part of emergency medicine. Chronic pain conditions are also among the leading complaints that primary care physicians receive every day. In the United States, approximately 100 million people are affected by severe or moderate pain. But then again, more than 100 deaths reported every day are from overdose resulting from years of misuse and addiction of opioids such as fentanyl and drugs such as heroin. With the growing opioid epidemic, the ethical and professional obligations of physicians to relieve pain and, at the same time, protect the patient from abuse has become a major issue in pain management.
While it is the obligation of physicians to relieve pain, it is also their responsibility to ensure that a patient is not a drug user who seeks to abuse pain medications. Identifying an individual as a “drug seeker” can also be challenging for physicians. A patient may be branded a “drug seeker” when their pain does not respond to standard pain dosage, and as a result, the issue of what and how much to prescribe arises due to fear of misuse and addiction. However, when dealing with end of life patients, the main goal is to relieve the pain and improve the quality of life for the patients. Depriving such patients enough pain medications is considered an ethical issue.
Another common dilemma arises when the patients lack the capacity to make their own health care decision regarding how they would like their pain managed. In such cases, close relatives of the patient become their surrogate. There have been numerous complaints by health care providers who disagree with a surrogate decision regarding how a patient’s pain should be managed. The ethical issue arises when a surrogate insists on no or extremely lower doses of pain medication for the patient despite obvious signs of pain in the patient.
Pain is a subjective measure, and a physicians’ assessment of pain relies on what the patient says it is and where they say it exists. This also becomes a challenge for physicians when deciding how much medication a patient needs. According to studies, between 21-29% of patients prescribed with chronic pain medication will misuse, risking the possibility of addiction.
The ongoing opioid crisis demands physicians to exercise the utmost caution when prescribing pain medications. The principle of beneficence states that health care providers should do what’s is good for the patient, while the principle of maleficence requires them to do no harm. These and principles of justice and autonomy form the basis upon which physicians can make effective decisions when faced with dilemmas regarding pain management.

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