Pain management and provider liability: No more excuses

Pain1 is undertreated in the American health-care system at all levels: physician offices, hospitals, longterm care facilities.2 The result is needless suffering for patients, complications that cause further injury or death, and added costs in treatment overall. The health-care system's failure to

Physicians have long been accused of poor pain management for their patients.3 The term "opiophobia" has been coined to describe this remarkable clinical aversion to the proper use of opioids to control pain.4 If the professional mandate of the health-care professional is to relieve suffering, then physicians are falling far short of their obligations5 by accepting myths about the use of opioids in the face of evidence to the contrary.6

The possible reasons for health-care providers' failures to property manage pain are many. First, physicians are poorly educated in medical school about narcotics and proper pain management, and they remain ignorant in practice about appropriate treatment choices for pain management,7 often rapidly absorbing professional norms that simply reflect a culture hostile to drug use.8 Second, threats of legal action loom large in providers' vision: criminal prosecution for use of controlled substances; sanctions involving the loss of hospital staff privileges for use of opiates; medical licensing board disciplinary action; and so on. Uncertainty about legitimate opioid use, coupled with a regulatory system that threatens sanctions, intimidates physicians.9 Third, patients, worried about tolerance and addiction to the opioids, receive little adequate information or education by providers.10 Patients suffer unnecessary pain as a result.11 Fourth, lack of insurance coverage may deny patients access to costly long-term pain management with its multiple modalities of treatment.12