No Pill for Chronic Pain

Bob Twillman, PhD

American Academy of Pain Management

If there was one thing I could do to relieve pain in America, it would be to have everyone understand that no pill, no shot, no surgery will relieve the vast majority of chronic pain.

Chronic pain is relieved only when there is a joint effort, on many fronts, of the person with pain, his or her healthcare providers, and those in his or her social milieu, to address ALL of the aspects of pain. This means focusing not only on the biological components of pain, but also on its behavioral, cognitive, emotional, social, and spiritual aspects.

By attending to all of these components of the pain experience, it may be possible for people with chronic pain to return to wellness, even if their pain does not completely go away. That is to say, they may be well emotionally, spiritually, cognitively, behaviorally, and socially even if they continue to experience some pain.

That state of overall wellness should be the goal for which we strive in treating chronic pain.

Note: September is Pain Awareness Month. For information on activities conducted by the Center for Practical Bioethics click here.

If there's one thing I would do to relieve pain in America ...

Daniel S. Goldberg, JD, PhD

East Carolina University

I would do everything in my power to convince both providers and pain sufferers to rid themselves of the idea that one must be able to see and objectify pain in order for it to be legitimized and treated properly.

The capacity to correlate discrete, material pathologies with illness complaints is a phenomenon that is literally constitutive of Western allopathic medicine, from the early 19th century to the present. As the quintessential subjective experience, pain defies objectification, and the vast majority of chronic pain experiences are literally defined by the absence of a material lesion that can be so correlated.

Yet such clinical sight is simply not necessary either to validate the experiences of those who live with pain, or to use the various safe and effective remedies that exist to ameliorate such pain.

I also believe that this emphasis on objectification and visibility plays a role in the terrible prevalence and intensity of chronic pain stigma and inequities in diagnosing and treating pain, but laying out the argument is a subject for future posts . . .

Ultimately, the need to objectify and see pain, which has been documented among pain sufferers and caregivers as well as health care providers, is in my view a primary culprit in the devastating and inequitable undertreatment of pain.

Even though such a need is literally baked into the foundations of American medicine and science, we should reject it.

Link: Ethics and the Chronic Pain Stigma in Geriatric Populations, Daniel Goldberg, The Bioethics Channel