Pain Management

Growing attention to end of life care issues has spawned a new wave of studies and research. The American Society of Law, Medicine, and Ethics, for example, has published a special issue of the Journal of Law, Medicine, & Ethics as part of a multi-year project to address legal and regulatory barriers to effective pain relief. The results of this project and numerous other studies are listed below.

Alpers A. "Criminal Act or Palliative Care? Prosecutions Involving the Care of the Dying."

• Examines criminal investigations and prosecutions of physicians and nurses in connection with their care of dying patients and concludes that the criminal law has failed to protect patients and families and has significant power to deter appropriate pain management for dying patients.

Hoffmann, DE. "Pain Management and Palliative care in the Era of Managed Care: Issues for Health Insurers."

• Reports on empirical study of medical directors at Blue Cross Blue Shield Plans regarding their awareness of and response to issues of pain management and palliative care for their insured populations.

Jost, TS. "Public Financing of Pain Management: Leaky Umbrellas and Ragged Safety Nets."

• Examines the gaps and deficiencies in Medicare and Medicaid funding of pain relief, and explores the effects of Medicare and Medicaid fraud enforcement on pain management.

Martino, AM. "In Search of a New Ethic for Treating Patients with Chronic Pain: What Can Medical Boards Do?"

• Argues that a complex "ethic of underprescribing" underlies the continued reluctance of physicians to use opioids to treat chronic pain. She contends that state medical boards are uniquely positioned to promote a new ethic for pain management, but stresses the difficulties for boards in attaining this goal. She thinks success may hinge on whether boars can change their approach to pain management and persuade a skeptical medical community that adopting a risk for underprescribing will serve the long-term interests of patients and the profession.

Conant, L and A Lowney "The Role of Hospice Philosophy of Care in Nonhospice Settings."

• Argues that the hospice philosophy of care should be an integral part of the overall palliative goals of medicine.

Hyman, CS "Pain Management and Disciplinary Action: How State Medical Boards Can Remove Barriers to Effective Treatment."

• Outlines four practical steps through which boards of medicine can improve pain management provided in their jurisdictions.

Lo,B, K H. Rothenberg & M Vasko. "Appropriate Management of Pain: Addressing the Clinical, Legal, and Regulatory Barriers."

• Discusses the articles and resources developed by the Project and offers a description of its work.

Johnson, SH "Disciplinary Actions and Pain Relief: Analysis of the Pain Relief Act."

• Provides analysis and rationale for Pain Relief Act prepared by the Project on Legal Constraints on Access to Effective Pain Relief.

Joranson, DE and AM. Gilson "Improving Pain Management Through Policy Making and Education for Medical Regulators."

• Provides a critical review of trends in state medical regulatory policy concerning controlled substances for intractable pain.

Pisano, DJ "Controlled Substances and Pain Management: Regulatory Oversight, Formularies, and Cost Decisions."

• Examines role of federal and state oversight of controlled substances as well as how pharmacy makes product selections and cost-based decisions.

Portenoy, RK "Opioid Therapy for Chronic Nonmalignant Pain: Clinicians' Perspective."

• Examines evidence supporting traditional view of opioid therapy in managing chronic nonmalignant pain, and concludes that some patient populations can sustain analgesia without significant adverse effects.

Post et al. "Pain: Ethics, Cultures, and Informed Consent to Relief."

• Argues for a richer notion of informed consent to encompass the moral imperative to treat pain

Shapiro, RS "Health Care Providers' Liability Exposure for Inappropriate Pain Management."

• Examines implications of two court decisions involving pain management and considers courts' potential use of practice guidelines, state statutes, and changing institutional practices to assess suits for negligent provision of pain relief.

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