Ethical Considerations in Prescribing or Withholding Opioids for Chronic Pain

Abstract

Pain is among the most common reasons that patients seek help from their physicians in the United States: it is estimated that chronic pain results in up to $635 billion per year in health care costs and lost productivity.

The management of chronic pain is complex and can be problematic for many clinicians, as pain is a subjective complaint. It may present out of proportion to the severity of a patient’s injury, or it can present without any objective findings at all. Based on past experiences, some clinicians may be overly restrictive in their prescribing of opioids, which may prevent some patients with legitimate pain from receiving appropriate therapy.

As the number of people suffering from chronic pain has risen over the past few decades, so has the number of opioid prescriptions, and this has not come without consequences. Opioid dependence and addiction has increased, and poor opioid prescribing practices and opioid diversion has resulted in the non-medical use of pain relievers by an estimated 25 million people from 2002-2011.

Despite the prevalence of patients that suffer from chronic pain, very few physicians are formally trained in pain management. A reasonable ethical approach for all physicians is to seek guidance from the 4 basic bioethical principles – beneficence, non-maleficence, justice and autonomy – in order to identify the ethical challenges of employing opioids in the management of chronic pain.