title: The business of pain medicine: the present mirrors antiquity.
abstract: The practice of pain medicine is often considered a fledgling field, as are the economic, business, and related ethical issues associated with providing these services. This article first traces the history of pain care and its relationships to industry and business, as well as the impact of government regulations over the ages. The authors challenge the view that the commonly discussed health care issues facing pain medicine are new by tracing the business and regulatory-related antecedents of pain care practice from the first through 21st century. The controversies associated with the practice of delivering pain-related health care services in an ethical manner are discussed with specific reference to the early work of clinicians, health care activists, and policy makers. The early activities of noteworthy individuals such as Pliny the Great, Hua T'o, John Locke, Benjamin Franklin, Oliver Wendell Holmes Sr., William Morton, Henry and William James, Heinrick Dresser, and other recent health care activists are reviewed. Issues of practitioner liability and regulatory restrictions on practice are also discussed in a historical context. The authors conclude that familiar ethical dilemmas commonly arose in past centuries, and history may be repeating itself with respect to the concerns now being discussed within our field. These arguments are reflected against the pain medicine Ethics Charters of the American Academy of Pain Medicine throughout the document. Finally, we outline the challenges for the present and future. With an understanding of these eight historical events as a backdrop, we may be at an opportune time to better address these issues in a manner that could provide the most effective pain care in our society.
authors.affiliation: Craniofacial Pain and Headache Center, Tufts School of Medicine, Boston MA 02111, USA. rkulich@partners.org
authors.forename: Ronald
authors.initials: R
authors.lastname: Kulich
authors.forename: John D
authors.initials: JD
authors.lastname: Loeser
mesh_terms: D000698:Analgesia / Q000191:economics / Q000266:history* / Q000379:methods; D003695:Delivery of Health Care / Q000266:history* / Q000331:legislation & jurisprudence; D004345:Drug Industry; D004992:Ethics, Medical; D019317:Evidence-Based Medicine; D033161:Government Regulation; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D049690:History, Ancient; D049691:History, Medieval; D006801:Humans; D010146:Pain / Q000188:drug therapy*