PAIN: Do You Feel What I Feel?

Isaiah Beh
Professor Zealley
HS-2050-400
May 2, 2016

PAIN: Do You Feel What I Feel?

Everything becomes dull. The lights in the room seem to soften and
shudder. The song playing on the radio appears to drift into a far off room of
the house, as if someone picked up the stereo and walked away with it. The
fear this might not pass quickly, or not pass at all, envelops all other
thoughts. Something as simple as a toothache can paralyze a person,
causing them to disappear from reality and live solely in the realm of pure
pain. The only thought that can make it out of this realm is Help, please
make this pain stop.
Help is now the prime objective for a person in pain. Most people that
are suffering from acute pain cannot endure the pain long enough to
schedule a visit with their personal physician, so they end up at the
Emergency Room (ER). This point is where the dilemma begins; does the
doctor on staff have the right to refuse the person who is in pain opioid
based pain killers because she/he does not believe this person is truly in pain
and is only seeking the drugs for recreational use? Furthermore, is it ethical
for a doctor to prescribe opioid-based medications when it is known the
person seeking them has a history of drug abuse? Should a person be thrown
to the curb of an ER, with no relief from the pain they feel, simply because it
is difficult to express and convince the doctor that the pain they are
experiencing is very real and legitimate? There is a need for a personal and
standardized case-by-case procedure to protect people from the harm
caused by addiction to opioid-based drugs, and to ensure that people
experiencing pain receive adequate pain management.

PAIN: Do You Feel What I Feel?

Describing the pain one feels to another person can be like explaining
a dream you had to a person who has never slept. Trying to communicate
this feeling to a medical professional, in an attempt to seek help, is
becoming an increasingly difficult issue in modern healthcare. In 1975, the
International Association for the Study of Pain finally defined pain as an
unpleasant sensory and emotional experience associated with actual or
potential tissue damage, or described in terms of such damage [1]. How
can another person really understand someone elses unpleasant sensory
and emotional experience? The standard practice today is for the patient
(the person suffering from pain) to rate their level of pain on a one to ten
scale. One being not much pain at all, and ten being a I would rather die
than live through this experience. Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) introduced this pain scale in 1997 to
better help a patient communicate the level and severity of the pain they
were experiencing.
When this pain scale was introduced medical practitioners rushed to
meet and manage the pain of their patients, administering and prescribing
opiate-based pain relievers to anybody who reported a pain level of four or
higher. Seemingly, the issue of communicating the pain one felt to another
had been solved. By simply rating your level of discomfort, the medical
practitioner would take your word for it and do their best to manage that
pain. Although, this new approach may have created an even larger problem
than communicating the pain one feels. Opiate-based pain relievers are

PAIN: Do You Feel What I Feel?

highly addictive both mentally and physically. These medications can

adversely affect a persons health if abused. Between 1999 and the present,
there have been a 300 percent increase in the prescribing of opiates in the
U.S. The misuse and abuse of prescription painkillers has resulted in
approximately 500,000 emergency department visits annually [2]. In 2008
more than 36,000 Americans died from drug overdoses, most of them
caused by prescription opiates [3]. More than 12 million Americans admitted
using prescription opiates recreationally in 2010 [4].
The statistics backing up the problem with over prescribing opioids
show the pain scale ultimately put too much power into the patients hands.
This practice removed the doctors personal opinion of each pain case and
threw a blanket solution over pain management. This blanket solution has
created an epidemic of opioid abuse and has left many doctors very
suspicious of patients claiming chronic or acute pain. A domino effect has
now occurred; doctors now might be refusing patients with legitimate pain
access to opioid pain killers, because the long term effect of their over
prescribing of them in the first place. The breakdown in patient/doctor
communication and trust has clearly caused a very serious issue.
By looking at the Paradigm Boxes, a Bioethics tool with four sections
(Medical Indications, Patient Preferences, Quality of Life, and Contextual
Features) that help ensure the decision made is ethical, it is clear this
approach to pain management is not up to current ethical standards. First,
Medical Indications, or Do no harm; establishes if the patient can be

PAIN: Do You Feel What I Feel?

treated and how causing more pain or harm can be avoided. In the case of
pain management we see a huge issue: the patient can be treated for their
pain by administering opioid-based pain pills, but the long term affects of the
pills may cause harm to the patient. Second, Patient Preferences; respecting
the wishes of the patient allows the patient the ability to accept or refuse a
treatment option. When a patient is in pain and knows opioid-based pills will
relieve them of this pain, that option should be available for them. Third,
Quality of Life; how a patients life will be affected with and without
treatment. A person whom is reporting a 10 on the pain scale would clearly
say their quality of life is being lowered by not receiving treatment (pain
pills), although the doctor may see abusive behavior that will cause longterm loss in quality of life and thus refuse opioid treatment. Finally,
Contextual Features: outside parties that would benefit from a specific
treatment method such as pharmaceutical companies or doctors being paid
extra for prescribing opioids. In 2003, the FDA cited the manufacturer of
OxyContin twice for misleading promotional advertisements to physicians,
underplaying the addictive risks of the drug. In 2007, three executives of the
company pled guilty to charges of misleading the public about the drugs
safety and risk of abuse [5].
The ethical issues pointed out by the Paradigm Boxes are not
necessarily dead-end problems without solutions. By examining the ethical
issues created when opioid-based pills should and should not be used as a
treatment for pain management it is clear there needs to be a more personal

PAIN: Do You Feel What I Feel?

or case-by-case decision made. If a doctor knows the history of prescriptions

a patient has been taking, they are likely able to make a more informed
decision whether a patient would be at risk for abusing medications. Webbased prescription monitoring programs and legislation currently exists in 48
states and 1 territory. Access to this information allows doctors to check a
patients prescription history. By taking a few minutes to access these
databases doctors are given some insight into the negative patterns (if they
exist), like multiple ER visits for pain related issues, or doctor shopping
for a physician that will write prescriptions with little questions, and the use
of multiple pharmacies a person seeking to abuse opioid-based pills may
have.
Nevertheless, these patterns of behavior still might be related to a
legitimate medical issue causing these patients pain, therefore the use of
Narcotics Contracts should be used in cases where patients are at a high risk
for abuse. A narcotics contract is an agreement between a patient and
doctor that stipulates conditions that must be followed in order for a doctor
to prescribe opioid-based pain pills. Some of these stipulations may include,
but are not limited to, random pill counts to ensure a patient is not taking
more than the daily amount of pills, and random urine screenings to ensure
no other medications are being consumed that may endanger the patient. If
any of the stipulations of the contract is broken the prescribing doctor has
the ability to stop treatment immediately and reassess other treatment
options for the patient.

PAIN: Do You Feel What I Feel?

Pain will always exist in this world we live in, without pain there is no
beauty, but there is no need for people to experience too much of it. By
breaking down the current system in place for pain management, and
getting back to a more personal case-by-case diagnosis (instead of a
simple one to ten scale), medical professionals and patients can work
together to curtail pain and opioid abuse.

References
1. International Association for the Study of Pain. IASP taxonomy.
http://www.iasp-pain.org/Content/NavigationMenu/GeneralResourceLinks/
PainDefinitions/default.htm. Accessed April 28, 2016
2. US Department of Health and Human Services Substance Abuse and
Mental Health Services Administration Center for Behavioral Health Statistics
and Quality. Drug Abuse Warning Network, 2010: national estimates of drugrelated emergency department visits.

PAIN: Do You Feel What I Feel?

http://www.samhsa.gov/data/2k13/DAWN2k10ED/DAWN2k10ED.htm.
Accessed April 28, 2016.
3. Centers for Disease Control and Prevention. Vital signs: overdoses of
prescription opioid pain relievers---United States, 1999--2008. MMWR Morb
Mortal Wkly Rep. 2011;60(43):1487-1492.
4. US Department of Health and Human Services Substance Abuse and
Mental Health Services Administration Center for Behavioral Health Statistics
and Quality. Results from the 2010 National Survey on Drug Use and Health:
summary of national findings.
http://oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.htm#2.16. Accessed
April 28, 2016.
5. Company admits painkiller deceit. Washington Times. May 11, 2007.
http://www.washingtontimes.com/news/2007/may/10/20070510-1032374952r/print/. Accessed April 28, 2016.