Contextualizing and individualizing truth-telling about pain in a tough and unjust world

摘要

We consider recent research findings regarding patients’ individual pain perception and phenotype, embodied in the altered neural network vulnerability, the result of connatal setup and acquired exposure, to question Dr. Gligorov’s inferences. We contextualize Dr. Gligorov’s discourse with concrete clinical cases embedded in obstetric anesthesia scenarios, where physicians may knowingly administer placebo pain medication and where truth-telling about pain has important immediate and long-term clinical consequences, in particular during subsequent repeated clinical encounters. Furthermore, truth-telling about pain implies acknowledging the social and economic context in which pain is treated, or more often not treated. In particular minorities and indigent populations are routinely undertreated for pain due to structural or individual bias driving cruel healthcare disparities. Finally, we argue that the patients’ viewpoint is lacking in this debate at present but all stakeholders’ perspective are important in the discussion of truth-telling about pain.