An Ethical Analysis of the Barriers to Effective Pain Management

Abstract

Among the most significant findings of SUPPORT was that 50% of ICU patients suffered from moderate to severe pain during the last days of life. At the time of its publication late in 1995, SUPPORT was merely the latest in a long series of articles in the medical literature documenting the widespread and significant undertreatment of pain, beginning with a 1973 study of hospital inpatients. Much has been written about the phenomenon of undertreated pain and inadequate care of patients at the end of life, and many positive suggestions for reform of clinical education and clinical practice have been iterated and reiterated in the two decades separating the studies. Proposals for modifying clinician behaviors in this aspect of patient care have tended to focus on particular barriers to effective pain management and palliative care.

The agony of agonal respiration: is the last gasp necessary?

“…First, the general duty to alleviate pain and suffering supports a decision to alleviate the pain and suffering associated with agonal respiration; relieving pain and suffering is a good goal. 48 Second, as mentioned earlier, gasping respirations may not be influenced by analgesics and sedatives routinely used in end of life care. When adequate doses of sedatives and analgesics have been provided and the patient continues to have agonal, gasping respirations (as in our illustrative cases) the use of neuromuscular blocking agents, in proper dose, would terminate the gasping respirations.…”

Pain assessment tools: children’s nurses’ views

“…that pain might have profound deleterious effects on children (Franck, 1998;Morton, 1998;Rich, 2000). Despite this growth of evidence-based pain literature, a persistent theory-practice gap exists, which mitigates against the introduction and use of valid and reliable pain assessment tools.…”

The War on Drugs Versus the War on Pain: Surviving Two Perfect Storms

“…The irony of the inclusion of organizations such as the Joint Commission and the Federation of State Medical Boards in the Finance Committee's dragnet is that both had been widely praised for recognizing that widespread myths, misinformation, ignorance and fear had been at the root of the epidemic of undertreated pain in the USA [9]. By including pain management in the accreditation standards of the Joint Commission, and developing and disseminating a model policy that clearly stated that effective pain management was an essential element of quality patient care, there was increased optimism that clinicians would be educated and empowered to competently and compassionately address pain in their patients.…”