Psychosocial/Ethical/M.D. Wellness

Topic 1 - Summary
1. Citation:

Ethical Framework for management of pain in the ED

2. Summary/Bottom Lines:
  • This article starts by talking about the significance of pain and how often we see it in the ED.  They then give 13 year old statistics about how we don’t treat it properly.

  • The paper then talks about various ethical paradigms including: Autonomy, Beneficence, nonmaleficense, Justice, Consequentialism/Utilitarianism, Nonconsequentialism/Kant’s Categorical Imperative, Virtue Theory, Narrative and relationship theories.  The conclusion is that none of these apply to all situations.

  • Acute Nonrecurrent Pain: Basically all theories say treat it how you see fit with the exception of giving narcotics to pains that lack evidence for their use such as dental pain or musculoskeletal pain.

  • Acute Exacerbation of Chronic Pain:  How you treat their pain in the ED may be different from the medications you send them out on.  Don’t give them something euphoric if you think they have secondary intentions (duh).  Once again don’t give narcotics for things they have not shown to help such as fibromyalgia, arthritis, migraine, pain, and recurrent back pain.  Drug monitoring programs are very useful for this type of pain.  If you must give opiates give small amounts (72 hours).

  • Chronic Persistent Pain: Remember high risk patients develop serious medical conditions too.  Opiates rarely effective for chronic pains.  Pursue other routes of treatment such as lidocaine patches, anticonvulsants, and antidepressants.  Every patient with chronic pain should receive timely follow-up.  Be careful with how you talk to patients in this category and always document facts rather than documenting they are drug seeking.  If your patient has cancer there is little ethical controversy to treating it as you see necessary.

3. Methods:
  • ethical paper
4. Limits:
  • ethical paper
5. Additional Info:

 

6. Author: Dr. Mike Lindsey