Ethical perspectives: opioid treatment of chronic pain in the context of addiction.
The authors apply eight ethical domains of analysis to the question of treatment of chronic pain with opioids in patients with histories of substance use disorders: autonomy, nonmaleficence, beneficence, justice, medical condition, patient preference, quality of life, and consideration of specific individual or sociocultural issues. These eight domains are drawn from principle-based and case-based ethical perspectives. The domains are developed by review of available literature and through application to a specific presented case. Factors that interfere with rational, ethical decision-making regarding opioid pain management are identified. Chronic pain and substance use disorders share a history of stigmatization, underdiagnosis, and undertreatment. Using the presented case as a point of departure, the authors discuss principles for prescription of opioids for treatment of chronic noncancer pain in the setting of history of substance use disorders.
Cohen
Mitchell J M
MJ
Pain Medicine Program, Department of Psychiatry and Human Behavior, Jefferson Medical College, Philadelphia, Pennsylvania 19107-4414, USA. Mitchell.J.Cohen@mail.tju.edu
Jasser
Samar
S
Herron
Patrick D
PD
Margolis
Clorinda G
CG
D002908:Chronic Disease; D015510:Clinical Medicine; D003657:Decision Making / Q000941:ethics; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy; D034723:Double Effect Principle; D004992:Ethics, Medical; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D009293:Opioid-Related Disorders / Q000209:etiology*; D010146:Pain / Q000150:complications / Q000188:drug therapy*; D026684:Personal Autonomy; D028662:Principle-Based Ethics
D009294:Narcotics