BOX S-1
Underlying Principles

  • A moral imperative. Effective pain management is a moral imperative, a professional responsibility, and the duty of people in the healing professions.
  • Chronic pain can be a disease in itself. Chronic pain has a distinct pathology, causing changes throughout the nervous system that often worsen over time. It has significant psychological and cognitive correlates and can constitute a serious, separate disease entity.
  • Value of comprehensive treatment. Pain results from a combination of biological, psychological, and social factors and often requires comprehensive approaches to prevention and management.
  • Need for interdisciplinary approaches. Given chronic pain’s diverse effects, interdisciplinary assessment and treatment may produce the best results for people with the most severe and persistent pain problems.
  • Importance of prevention. Chronic pain has such severe impacts on all aspects of the lives of its sufferers that every effort should be made to achieve both primary prevention (e.g., in surgery for a broken hip) and secondary prevention (of the transition from the acute to the chronic state) through early intervention.
  • Wider use of existing knowledge. While there is much more to be learned about pain and its treatment, even existing knowledge is not always used effectively, and thus substantial numbers of people suffer unnecessarily.
  • The conundrum of opioids. The committee recognizes the serious problem of diversion and abuse of opioid drugs, as well as questions about their long-term usefulness. However, the committee believes that when opioids are used as prescribed and appropriately monitored, they can be safe and effective, especially for acute, postoperative, and procedural pain, as well as for patients near the end of life who desire more pain relief.
  • Roles for patients and clinicians. The effectiveness of pain treatments depends greatly on the strength of the clinician–patient relationship; pain treatment is never about the clinician’s intervention alone, but about the clinician and patient (and family) working together.
  • Value of a public health and community-based approach. Many features of the problem of pain lend themselves to public health approaches—concern about the large number of people affected, disparities in occurrence and treatment, and the goal of prevention cited above. Public health education can help counter the myths, misunderstandings, stereotypes, and stigma that hinder better care.

THE NEED FOR A CULTURAL TRANSFORMATION IN THE WAY PAIN IS VIEWED AND TREATED

Pain serves a vital function as a warning sign of injury or infection, but once its warning role is over, continued pain is maladaptive. Chronic pain results in many changes in the peripheral and central nervous systems that aid in its per-



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