Pain and Pain Management Health Article

Pain and Pain Management

The diagnosis and treatment of various kinds of pain; ethical issues involved in providing, or more commonly, withholding such treatment.

In 1994, the New England Journal of Medicine published a forum on ethical questions concerning pain management in children. The forum began its discussion by acknowledging that the medical community at large fails to provide effective pain relief for children and infants. The forum cited recent studies which found that "pain can be relieved effectively in 90 percent of patients but is not relieved effectively in 80 percent of patients." In children the failure to relieve pain is even more pronounced. Forum participants cited a study which found that postoperative analgesics were administered to children far more infrequently, or in lower doses, than to adults—even when both had undergone the same operation.

The forum considered several issues regarding the medical establishment's reluctance to provide pain relief for children and arrived at some interesting conclusions. For one, it stated that "Denial of relief from pain that is proportionate to the expressed need for such relief must be judged an unjustified harm, unless such deprivation serves a substantially greater good." It characterized as "undocumented lore" the belief among practitioners that giving narcotic painkillers to children could lead to a life of drug addiction. The forum implored pediatricians to rely instead on empirical data, none of which has found a link between opioid treatment of pain and drug addiction. Finally, acknowledging that research published in journals often has little impact on actual doctor practices, participants in the forum concluded their discussion with a call for "specific administrative interventions" to eradicate the currently inadequate standards of pain management for infants and children. The authors encourage "pressure from parents" to force doctors to take a child's expressions of pain as seriously as they would an adult's.