Pain Medicine: Business or Profession?

Michael E. Schatman, PhD


May 13, 2011

In This Article

Pain Medicine and Profession

The quality of pain care in the United States has deteriorated over the past decade, to the extent that the state of the science(s) has been described as a "crisis."[1,2,3] Many in the pain care community believe that the primary reason for this retrogression has been pain medicine's devolution from a "profession" to a mere "business." This brief article examines aspects of this unfortunate transformation, discusses ethical implications, and describes some of the efforts that are being made to help restore the field to its noble roots as a means of enhancing quality of care, thereby reducing unnecessary suffering.

The profession of medicine has its roots in the belief that healers "profess,", ie, publicly proclaim, their altruism and willingness to subordinate their own self-interests in order to help, heal, or relieve pain, suffering, and disability.[4] Much has been written in regard to the need for such a virtue ethics approach to pain medicine.[2,5,6,7,8] Tragically, however, progressively more physicians are becoming inordinately concerned with their own needs rather than with the well-being of their patients.[9,10] Lebovits[11] will address this issue more thoroughly in a forthcoming article in a special ethics series in Pain Medicine. However, a concrete example of physician greed compromising the quality of care available to chronic pain sufferers will be appropriate here.

In the state of Washington, shortsighted and ill-advised zealots in the pain medicine field promoted legislation that will make prescription of opioid analgesics to patients in need considerably more difficult, as well as putting physicians at greater risk for regulatory sanction for prescribing. Given the empirically established shortage of "pain specialists" in the United States,[12] most of the care of chronic pain has, by necessity, fallen into the hands of primary care physicians.[13] With the new legislation (scheduled to go into effect this summer) looming, primary care physicians have become reticent with regard to opioid prescription, with many practices now displaying signs in their offices informing patients that they no longer prescribe opioids. Of interest, a small number of primary care physicians who claim to be pain specialists who have histories of prescribing high-dosage opioids freely, with some of them failing to integrate risk mitigation strategies into their practices. Some of these physicians have chosen to move their practices into cash-only entities, charging exorbitant fees for essentially prescribing opioid analgesics. Patients who need opioids in order to maintain a reasonable quality of life are forced to seek treatment from these physicians because many who had prescribed responsibly have become intimidated by the new legislation. Somehow, such maleficent practice remains legal.


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