CERGM’s Position on the Ethical Management of Chronic and Persistent Pain

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By R Carter

In my first year of anesthesia training I was called in for an emergency gunshot wound to the chest. When I arrived I was surprised to find the patient was stable, awake, cognitive but in a good deal of pain. I prepared for a typical crash induction only to be directed by the surgeon not to induce anesthesia. Instead, the surgeon wanted the patient left awake until after he had entered the chest cavity, on the outside chance there was a tamponade; a closed cavity where the pressure was preventing further hemorrhage.

Unprepared for such a request I objected, only to be overruled. So how do you prepare someone for having their chest cut open while awake? Anesthesia providers rely on what’s called retrograde amnesia an effect which occurs based on the amount and types of drugs given, but in circumstances like this, it’s not a guarantee. Still, if done well, the individual will have no recall of events leading up to the surgery, as much as an hour or more.

Upon making the incision the patient screamed and passed out at which point I slipped him a little Ketamine and Versed as amnesia insurance. The point is, the patient passed out and this event put me on a course of investigating what happens in humans when faced with an intense amount of pain. That led to a better understanding of chronic pain as well.

Following the surgery, my patient remembered only an intense pain on incision and nothing more, so he was spared the trauma of what followed. I like to believe that despite the directions I was given, my choice to use a safe combination of medications spared him the worst of what occurred.

Acute and chronic pain are not the same as evidenced by the responses people have. In acute pain the mind protects itself by making someone lose consciousness. In chronic pain, the sufferer is not so lucky, they must endure the experience. The changes it causes over time are far more devastating, even though they are not immediately life threatening.

In chronic pain quality of life suffers and those dependent on the individual suffer with them, so chronic pain is not an individual experience, like addiction, it has consequence for an entire family, a fact I think anti-opiate proponents often lose sight of.

I would hope that what they are advocating for is a more responsible use of opiates, not their elimination. For the occasional John Wayne type who advocates for no opiates, his days are numbered. If anything is certain, they will eventually face a failure of their body and that which comes it, the pain which is inevitable.

CERGM’s position on Chronic and Persistent Pain

  • 28% of the public suffers from some form of chronic pain which limits or impairs their ability to live a normal life.
  • CERGM’s goal is to educate about the differences between chronic pain management, drug dependence, addiction, abuse and what constitutes addictive behavior when using controlled substances.
  • Chronic pain is not a symptom or a syndrome, after more than three months it is better classified as a disease according to ICD standards. With physiological causes that negatively affect the individual, physically, emotionally, mentally and spiritually.
  • Chronic pain, treated or untreated, has a progressive and incapacitating effect, resulting in lost of function and a shortened life span.
  • As a disease chronic pain patients deserve relief as much as any other sick patient or even those with acute pain.
  • To confront and educate those who, without facts, stereotype, profile and assume chronic pain patients are individuals with aberrant, socially unacceptable or criminal behavior.
  • To work as an advocate for the responsible treatment of chronic pain with opiates when justified.
  • Advocating for the rights of chronic pain patients within the healthcare profession, other agencies and law makers within state and federal government, participating as needed in campaigns, seminars and events.
  • Work with healthcare professionals, insurance agencies, Medicare and Medicaid in treating the whole spectrum of debilitating effects of chronic pain by establishing realistic and positive goals for evidence based treatment outcomes.
  • Improve access to healthcare and information for those who have lost work or careers. Identify supportive agencies within state and federal government, provide self-help information and educational opportunities that lead to gainful employment and restore access to healthcare.
  • Educate pain patients about their disease and through education improve their quality of life and life expectancy.
  • Provide a world wide web monitored but open forum for discussion on issues specific to chronic pain and its management.