The Bioethics of Pain Management : Beyond Opioids

165 Pages·2014·0.862 MB·English

by  Daniel S. Goldberg

The Bioethics of Pain Management

In this book, public health ethicist Daniel S. Goldberg sets out to charac-
terize the subjective experience of pain and its undertreatment within the
U.S. medical establishment, and puts forward public policy recommenda-
tions for ameliorating the undertreatment of pain. The book begins from
the position that the overwhelming focus on opioid analgesics as a means
for improving the undertreatment of pain is fl awed, and argues instead that
dominant Western models of biomedicine and objectivity delegitimize sub-
jective knowledge of the body and pain in the U.S. This general intolerance
for the subjectivity of pain is part of a specifi c American culture of pain in
which a variety of actors take part, including not only physicians and health
care providers, but also pain sufferers, caregivers, and policymakers. Con-
centrating primarily on bioethics, history, and public policy, the book brings
a truly interdisciplinary approach to an urgent practical ethical problem.
Taking up the practical challenge, the book culminates in a series of policy
recommendations that provide pathways for moral agents to move beyond
contests over drug policy to policy arenas that, based on the evidence, hold
more promise in their capacity to address the devastating and inequitable
undertreatment of pain in the U.S.
Daniel S. Goldberg is Assistant Professor in the Department of Bioethics and
Interdisciplinary Studies in the Brody School of Medicine at East Carolina
University, N.C.
Routledge Annals of Bioethics
Series Editors: Mark J. Cherry , St. Edward’s University, USA ,
Ana Smith Iltis , Saint Louis University, USA
1 Regional Perspectives 9 The Ethics of Abortion
in Bioethics Women’s Rights, Human Life,
Edited by Mark J. Cherry and the Question of Justice
and John F. Peppin Christopher Kaczor
2 Religious Perspectives on 10 Bioethics, Public Moral
Bioethics Argument, and Social
Edited by Mark J. Cherry, Responsibility
Ana Smith Iltis, and Edited by Nancy M. P. King
John F. Peppin and Michael J. Hyde
3 Research Ethics
11 The Ethics of Gender-Specifi c
Edited by Ana Smith Iltis
Disease
Mary Ann Cutter
4 Thomistic Principles
and Bioethics
12 Death, Posthumous Harm,
Jason T. Eberl
and Bioethics
James Stacey Taylor
5 The Ethics of Genetic
Engineering
13 Human Dignity in
Roberta M. Berry
Bioethics
From Worldviews to the
6 Legal Perspectives in
Public Square
Bioethics
Edited by Stephen Dilley
Edited by Ana Smith Iltis,
and Nathan J. Palpant
Sandra H. Johnson, and
Barbara A. Hinze
14 Parental Obligations
7 Biomedical Research and Bioethics
and Beyond The Duties of a Creator
Expanding the Ethics of Inquiry Bernard G. Prusak
Christopher O. Tollefsen
15 The Bioethics of Pain
8 Practical Autonomy Management
and Bioethics Beyond Opioids
James Stacey Taylor Daniel S. Goldberg
The Bioethics of Pain
Management
Beyond Opioids
Daniel S. Goldberg
First published 2014
by Routledge
711 Third Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
Routledge is an imprint of the Taylor & Francis Group,
an informa business
© 2014 Taylor & Francis
The right of Daniel S. Goldberg to be identifi ed as author of this work has
been asserted by him/ her in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or
utilized in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in any
information storage or retrieval system, without permission in writing from
the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identifi cation and explanation
without intent to infringe.
Library of Congress Cataloging-in-Publication Data
The bioethics of pain management : beyond opioids / edited by
Daniel S. Goldberg.
pages cm. — (Routledge annals of bioethics ; 15)
Includes bibliographical references and index.
1. Chronic pain—Treatment—United States—Moral and ethical issues.
2. Opioids—Therapeutic use—Moral and ethical issues. 3. Opiod abuse—
United States. 4. Medical ethics. I. Goldberg, Daniel S., 1977–
editor of compilation.
RC483.5.O64B56 2014
174.2'90472—dc23
2013037045
ISBN: 978-0-415-74673-1 (hbk)
ISBN: 978-1-315-79745-8 (ebk)
Typeset in Sabon
by Apex CoVantage, LLC
Contents
List of Figures vii
Acknowledgements ix
Preface xi
Introduction: The Power of the Visible and the
Undertreatment of Pain in the U.S. 1
SECTION I
The Lived Experience of Pain 11
1 The Current State of Pain in the United States 13
2 The Lived Experience of Pain 23
SECTION II
History, the Power of the Visible, and Pain 35
3 The History of Pain without Lesion in Mid- to
Late-Nineteenth-Century America 37
4 Objectivity, Subjectivity, and Why the History of Pain
is Relevant to Its Contemporary Undertreatment 52
SECTION III
Ethics, Subjectivity, and Pain 63
5 Mind-Body Dualism, Subjectivity, and Consciousness 65
6 Pain, Objectivity, and Bioethics 80
vi Contents
SECTION IV
Towards Ethical, Evidence-Based Pain Policy 95
7 Opioids and Pain Policy 97
8 Evidence-Based Pain Policy Recommendations 111
Conclusion 136
Afterword 141
Index 145
Figures
1.1 Pain prevalence in the past month among adults 20 years
old and older, 1999–2002. 14
1.2 Pain duration, 1999–2002. 14
1.3 Low back, neck, migraine, and face pain in past
3 months, 2004. 15
1.4 Health status measures for adults with/without recent
low back pain, 2004. 16
1.5 Low back pain in last 3 months, 2004. 17
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Acknowledgements
This book could not have been completed without the patience, guidance,
and understanding of a great many people. I would fi rst like to thank all of
my professors and colleagues at the Institute for the Medical Humanities in
the University of Texas Medical Branch for creating an educational experi-
ence that has forever changed me. In particular, I would like to thank the
members of my dissertation committee: Howard Brody, Melvyn Schreiber,
Michele Carter, Jason Glenn, and Ben Rich for continually challenging me.
Bill Winslade, the chair of my committee, has been my mentor, advisor, and
confi dant for almost 15 years. I cannot thank him enough, nor heap enough
credit upon him for whatever I have managed to accomplish.
Special thanks go to the series editors for the A nnals of Bioethics, Mark
Cherry and Ana Iltis, for believing in the project and for their stewardship
during the editing and review process.
I owe a great debt of gratitude to my colleagues in the Department of
Bioethics & Interdisciplinary Studies at East Carolina University. Particular
thanks is owed to Kenneth A. DeVille and Todd Savitt for shepherding me
through the process of revising and improving this book.
I must thank my family of origin—Mom, Dad, Josh, Seth, and Zeide—
for the honey on the pages of my books. To my wife Yuko Kishimoto, Ph.D.,
no words of gratitude are suffi cient, only a life spent building a building.
Finally, to my daughter Maya: may your ship sail far away from the shores
of pain.