Virtual Mentor. May 2013

This month in Virtual Mentor

Ethics of Pain Measurement and Management

Upwards of 100 million Americans have it. There is no diagnostic test for it. Treatment options are often inadequate, and some people pretend to have it when they don’t. Contributors to the May issue of Virtual Mentor explain why each of these statements about pain is true, and explore clinical approaches that lie between the underestimation and overtreatment of pain. Three themes emerge; (1) pain is a subjective experience, influenced by physical, social, and cultural factors and, hence, immeasurable, (2) management, especially of long-term pain, is difficult, and (3) pain is costly to patients and society, so responsible pain management is urgently needed.

Ethical Perspectives on Pain Bharat Kumar, MD Beyond consensus that pain is “an unpleasant sensory and emotional experience,” its biology remains poorly understood, and options for its treatment remain frustratingly inadequate.

Drug Seeking or Pain Crisis? Responsible Prescribing of Opioids in the Emergency Department Commentary by Pamela L. Pentin, JD, MD Addicts quickly learn the diagnoses that cannot be definitively confirmed or ruled out by examinations or test results but that elicit prescriptions for opioid pain management.

Pain and the Paintbrush: The Life and Art of Frida Kahlo Fernando Antelo, MD In the iconic painting Broken Column, Kahlo represents her spine as a Greek column that is fractured and disintegrating. In this beautiful and tragic interpretation, the fractured column bespeaks Kahlo’s physical weakness and emotional instability.

Common Misconceptions about Opioid Use for Pain Management at the End of Life Commentary by Jack M. Berger, MS, MD, PhD, and Nalini Vadivelu, MD Guidelines for the use of controlled substances for the treatment of pain now consider inappropriate treatment, including undertreatment of pain, a departure from an acceptable standard of practice.

Upcoming Issues

• June Physician Leadership and Team-Based Care
• July Incentives and Motivation in Medical Care
• August Ethics in Cancer Prevention and Care
• September Motherhood and Medicine