title: Chronic pain treatment: a high moral imperative with offsetting personal risks for the physician--a medical student's perspective.
abstract: There is a clear need for physicians who specialize in the treatment of chronic pain, and these specialists must be empowered to use legally available and medically acceptable pain therapies, including opioids. However, prescribing opioids (or not prescribing them) for chronic pain treatment exposes pain physicians to medicolegal risks with serious personal consequences. This article summarizes, from a medical student's perspective, the basis for the specialization in pain medicine, and actions that place pain physicians at risk for serious professional harm. Regulatory issues of opioid prescription, physician litigation, and the ethical and legal implications on pain management from the perspective of a medical student are discussed. Existing data suggest that legal and regulatory issues have impacted and will continue to impact the treatment of pain. Creating uncertainty about legal issues and instilling fear in the prescribing physician are the best ways to discourage the use of opioids for legitimate medical purposes. In addition, the personal risks associated with the treatment of pain are likely to deter medical students from choosing pain management as their specialty. It is concluded that pain management is both a moral imperative and a moral obligation of clinicians that stems from the Hippocratic Oath. It is clear that there are many misconceptions and ethical concerns surrounding the use of opioids to treat pain. It is imperative that legal and regulatory issues do not discourage medical students from specializing in pain medicine.
authors.affiliation: School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas 79430, USA. jon.nathan@ttuhsc.edu
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Nathan
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D002908:Chronic Disease; D004501:Education, Medical / Q000941:ethics / Q000331:legislation & jurisprudence; D006801:Humans; D028681:Moral Obligations; D059408:Pain Management; D010820:Physicians / Q000941:ethics* / Q000331:legislation & jurisprudence*; D012306:Risk; D013337:Students, Medical
chemical_list: D000701:Analgesics, Opioid