Principles to Guide Pain Care

The crisis of opioid overdose has led us to the challenge of balancing compassionate and effective treatment of pain against the risks of medication misuse, all in an environment of political and regulatory reactiveness. What are the core ethical principles to help ensure that the needs of patients are not forgotten? How can we work with them? We must balancing these principles and try to mold them in every situation, knowing that in some cases and situations, one may be overarching or overriding, and in other cases and situations, another one may take precedence. That’s okay. But no matter what happens, those principles are rock solid, and they’re not going to change. In my mind, that’s a good reproducible approach to managing patients with chronic pain no matter what happens outside of them.

The 4 ethical principles that should guide people in treating pain patients:

• Autonomy—I happen to consider autonomy to be #1. No matter what happens, the patient has the right to say “Yes” or “No” in every single situation, or at least the proxy does if the patient is not able to make their own decisions.
• Nonmaleficence—Many people believe nonmaleficence to be the overriding or overarching principle: “Do no harm” is probably the phrase that most people are familiar with when they take the Hippocratic Oath.
• Justice—The idea that, no matter what you do, it must coincide with what legal aspects dictate. As guidelines change and regulatory scrutiny increases, it’s very important for healthcare providers to understand that they need to consider justice in the risk-benefit analysis to keep themselves out of trouble from a practice perspective.
• Beneficence—What’s most likely to benefit the patient? Every patient is different. What’s going to benefit patients is never going to be exactly the same.