5 ms·

Isn't there a professional and ethical obligation to prescribe painkillers to people who are in significant pain?

baxtr 7y ago
I guess it depends. In other countries, like Germany, doctors have a very different stance on people in pain. “Pain is a part of life. We cannot eliminate it nor do we want to. The pain will guide you. You will know when to rest more; you will know when you are healing. If I give you Vicodin, you will no longer feel the pain, yes, but you will no longer know what your body is telling you. You might overexert yourself because you are no longer feeling the pain signals. All you need is rest. And please be careful with ibuprofen. It’s not good for your kidneys. Only take it if you must. Your body will heal itself with rest.” From: https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-germany-vicodin.html https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-ge...
- grabbalacious 7y ago
  Yes. When stubbing a toe I've historically employed two strategies for dealing with it. In my youth I would shout and hop around the room, i.e. distract myself. Nowadays I pay as much attention to the pain as is possible and practical. Remarkably this approach does seem to alleviate the pain. So my guess is that the function of pain is to direct attention to injury. Not just for thinking about ways to avoid repeat injuries but purely and simply to promote the healing response. Which is not to say that I wouldn't welcome a painkiller if the pain was great enough. It's just that the suffering caused does seems to increase with the efforts one makes to distract oneself from it.
  - Ididntdothis 7y ago
    There is a level of pain where it becomes totally debilitating and all consuming. I can meditate over light headaches or other pain but from time to time I get migraines where I either want to die or take anything that will make it go away.
    - grabbalacious 7y ago
      With very severe pain I don't see why one couldn't adopt a dual strategy of alleviating it both with drugs and by focussing on it during its most intense moments.
- 904baf11 7y ago
  > Your body will heal itself with rest. Love too keep my arm permenantly lowered because ibuprofen is evil and rest is good
  - adrianN 7y ago
    Ibuprofen is an OTC medicine in Germany.
- Mo3 7y ago
  I'm German and that is highly exaggerated. While doctors here are in fact very careful and conversative with opiates, if you need them, you get them. Almost all of the people with chronic pain I know get opiates, or cannabis.
- p410n3 7y ago
  While that is exaggerated, it's close to what many people here think
loopback_device 7y ago
I would argue that the obligation should rather lie in finding the cause of the pain, and working on fixing that, rather than fixing the symptoms
- lotsofpulp 7y ago
  Suppose it takes time to figure out and fix the cause of the pain, or is impossible to find the cause and/or fix it.
- umvi 7y ago
  My neighbor got addicted to opioids after he got in a motorcycle accident and broke many bones. He eventually broke the addiction but said he was super grateful for opioids. So, yeah... sometimes the source of the cause of pain is "multiple broken bones"
- perl4ever 7y ago
  Terminal cancer sucks.
- philwelch 7y ago
  Have you ever been on call? Imagine that you are on call, and you get paged for something, and there is no way to stop the page from going off even though you're aware of the issue and trying to resolve it. You could also, if you'd like, imagine that your alarms were misconfigured and they were going off for literally no good reason, but there was no way to silence the mechanism that's paging you. It's kind of like that.
eurasiantiger 7y ago
There is. However, opioids also treat psychological pain and inhibit anger and rage - these are some of the unspoken reasons people from abusive backgrounds become so easily dependent on opioids. Note that dependence here is distinct from addiction.
pdonis 7y ago
> Isn't there a professional and ethical obligation to prescribe painkillers to people who are in significant pain? No. There is a professional and ethical obligation to inform patients of the options available, and the costs and benefits of each option, so that the patient can make an informed choice about what is best for them in their particular case. That includes informing the patient about how best to use painkillers: for example, that you should take them only if taking them benefits you more than not taking them (for example, only take them right before bed so the pain doesn't prevent you from sleeping, and the healing you get from sleep outweighs the risks involved with the painkiller).
- vo2maxer 7y ago
  There have been a number of updates and revisions of the medical code of ethics dating back to the Hippocratic Oath. Below is the American Medical Association Principles of Medical Ethics from 1957 [1], and for a longer look [2]. Section 1. The principle objective of the medical profession is to render service to humanity with full respect for the dignity of man. Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion. Section 2. Physicians should strive continually to improve medical knowledge and skill, and should make available to their patients and colleagues the benefits of their professional attainments. Section 3. A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily associate professionally with anyone who violates this principle. Section 4.The medical professional should safeguard the public and itself against physicians deficient in moral character or professional competence. Physicians should observe all laws, uphold the dignity and honor of the profession and accept its self-imposed disciplines. They should expose, without hesitation, illegal or unethical conduct of fellow members of the profession. Section 5. A physician may choose whom he will serve. In an emergency, however, he should render service to the best of his ability. Having undertaken the care of a patient, he may not neglect him; and unless he has been discharged he may discontinue his services only after giving adequate notice. He should not solicit patients. Section 6. A physician should not dispose of his services under terms of conditions which tend to interfere with or impair the free and complete exercise of his medical judgment and skill or tend to cause deterioration of the quality of medical care. Section 7. In the practice of medicine a physician should limit the source of his professional income to medical services actually rendered by him, or under his supervision, to his patients. His fee should be commensurate with services rendered and the patient's ability to pay. He should neither pay nor receive a commission for referral of patients. Drugs, remedies or appliances may be dispensed or supplied by the physician provided it is in the best interests of the patients. Section 8. A physician should seek consultation upon request; in doubtful or difficult cases; or whenever it appears that the quality of medical service may be enhanced thereby. Section 9. A physician may not reveal the confidences entrusted to him in the course of medical attendance, or the deficiencies he may observe in the character of patients, unless he is required to do so by law or unless it becomes necessary in order to protect the welfare of the individual or of the community. Section 10. The honored ideals of the medical profession imply that the responsibilities of the physician extend not only to the individual, but also to society where these responsibilities deserve his interest and participation in activities which have the purpose of improving both the health and the well-being of the individual and the community. [1] American Medical Association. Principles of medical ethics. Appendix F. 1957:355–257. In: Baker RB. The American Medical Ethics Revolution. Baltimore, MD: Johns Hopkins University Press. [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399321/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399321/
mattigames 7y ago
Maybe, but only if is attached to an ethical obligation of declaring how likely you are to become addicted, and how likely you are to die from overdose, and how likely is to create other permanent damages.

I guess it depends. In other countries, like Germany, doctors have a very different stance on people in pain. “Pain is a part of life. We cannot eliminate it nor do we want to. The pain will guide you. You will know when to rest more; you will know when you are healing. If I give you Vicodin, you will no longer feel the pain, yes, but you will no longer know what your body is telling you. You might overexert yourself because you are no longer feeling the pain signals. All you need is rest. And please be careful with ibuprofen. It’s not good for your kidneys. Only take it if you must. Your body will heal itself with rest.” From: https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-germany-vicodin.html https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-ge...

grabbalacious 7y ago
Yes. When stubbing a toe I've historically employed two strategies for dealing with it. In my youth I would shout and hop around the room, i.e. distract myself. Nowadays I pay as much attention to the pain as is possible and practical. Remarkably this approach does seem to alleviate the pain. So my guess is that the function of pain is to direct attention to injury. Not just for thinking about ways to avoid repeat injuries but purely and simply to promote the healing response. Which is not to say that I wouldn't welcome a painkiller if the pain was great enough. It's just that the suffering caused does seems to increase with the efforts one makes to distract oneself from it.
- Ididntdothis 7y ago
  There is a level of pain where it becomes totally debilitating and all consuming. I can meditate over light headaches or other pain but from time to time I get migraines where I either want to die or take anything that will make it go away.
  - grabbalacious 7y ago
    With very severe pain I don't see why one couldn't adopt a dual strategy of alleviating it both with drugs and by focussing on it during its most intense moments.
904baf11 7y ago
> Your body will heal itself with rest. Love too keep my arm permenantly lowered because ibuprofen is evil and rest is good
- adrianN 7y ago
  Ibuprofen is an OTC medicine in Germany.
Mo3 7y ago
I'm German and that is highly exaggerated. While doctors here are in fact very careful and conversative with opiates, if you need them, you get them. Almost all of the people with chronic pain I know get opiates, or cannabis.
p410n3 7y ago
While that is exaggerated, it's close to what many people here think

loopback_device 7y ago

I would argue that the obligation should rather lie in finding the cause of the pain, and working on fixing that, rather than fixing the symptoms

lotsofpulp 7y ago
Suppose it takes time to figure out and fix the cause of the pain, or is impossible to find the cause and/or fix it.
umvi 7y ago
My neighbor got addicted to opioids after he got in a motorcycle accident and broke many bones. He eventually broke the addiction but said he was super grateful for opioids. So, yeah... sometimes the source of the cause of pain is "multiple broken bones"
perl4ever 7y ago
Terminal cancer sucks.
philwelch 7y ago
Have you ever been on call? Imagine that you are on call, and you get paged for something, and there is no way to stop the page from going off even though you're aware of the issue and trying to resolve it. You could also, if you'd like, imagine that your alarms were misconfigured and they were going off for literally no good reason, but there was no way to silence the mechanism that's paging you. It's kind of like that.

eurasiantiger 7y ago

There is. However, opioids also treat psychological pain and inhibit anger and rage - these are some of the unspoken reasons people from abusive backgrounds become so easily dependent on opioids. Note that dependence here is distinct from addiction.

pdonis 7y ago

> Isn't there a professional and ethical obligation to prescribe painkillers to people who are in significant pain? No. There is a professional and ethical obligation to inform patients of the options available, and the costs and benefits of each option, so that the patient can make an informed choice about what is best for them in their particular case. That includes informing the patient about how best to use painkillers: for example, that you should take them only if taking them benefits you more than not taking them (for example, only take them right before bed so the pain doesn't prevent you from sleeping, and the healing you get from sleep outweighs the risks involved with the painkiller).

vo2maxer 7y ago
There have been a number of updates and revisions of the medical code of ethics dating back to the Hippocratic Oath. Below is the American Medical Association Principles of Medical Ethics from 1957 [1], and for a longer look [2]. Section 1. The principle objective of the medical profession is to render service to humanity with full respect for the dignity of man. Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion. Section 2. Physicians should strive continually to improve medical knowledge and skill, and should make available to their patients and colleagues the benefits of their professional attainments. Section 3. A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily associate professionally with anyone who violates this principle. Section 4.The medical professional should safeguard the public and itself against physicians deficient in moral character or professional competence. Physicians should observe all laws, uphold the dignity and honor of the profession and accept its self-imposed disciplines. They should expose, without hesitation, illegal or unethical conduct of fellow members of the profession. Section 5. A physician may choose whom he will serve. In an emergency, however, he should render service to the best of his ability. Having undertaken the care of a patient, he may not neglect him; and unless he has been discharged he may discontinue his services only after giving adequate notice. He should not solicit patients. Section 6. A physician should not dispose of his services under terms of conditions which tend to interfere with or impair the free and complete exercise of his medical judgment and skill or tend to cause deterioration of the quality of medical care. Section 7. In the practice of medicine a physician should limit the source of his professional income to medical services actually rendered by him, or under his supervision, to his patients. His fee should be commensurate with services rendered and the patient's ability to pay. He should neither pay nor receive a commission for referral of patients. Drugs, remedies or appliances may be dispensed or supplied by the physician provided it is in the best interests of the patients. Section 8. A physician should seek consultation upon request; in doubtful or difficult cases; or whenever it appears that the quality of medical service may be enhanced thereby. Section 9. A physician may not reveal the confidences entrusted to him in the course of medical attendance, or the deficiencies he may observe in the character of patients, unless he is required to do so by law or unless it becomes necessary in order to protect the welfare of the individual or of the community. Section 10. The honored ideals of the medical profession imply that the responsibilities of the physician extend not only to the individual, but also to society where these responsibilities deserve his interest and participation in activities which have the purpose of improving both the health and the well-being of the individual and the community. [1] American Medical Association. Principles of medical ethics. Appendix F. 1957:355–257. In: Baker RB. The American Medical Ethics Revolution. Baltimore, MD: Johns Hopkins University Press. [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399321/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399321/

mattigames 7y ago

Maybe, but only if is attached to an ethical obligation of declaring how likely you are to become addicted, and how likely you are to die from overdose, and how likely is to create other permanent damages.