Improving pain management: are we jumping from the frying pan into the fire?

摘要

The review article by Brennan, Carr, and Cousins (1) is a laudable effort to discuss the ethical, political, cultural, and legal challenges involved in trying to improve the management of both acute and chronic pain. Unfortunately, this largely philosophical review fails to provide convincing scientific arguments to support the authors' strongly held beliefs that many physicians fail to provide adequate pain relief because of a lack of concern and/or because of misconceptions regarding the use of analgesics in the management of pain (1-3). Although there is a clear need for improved techniques for controlling acute and chronic pain, we have serious concerns about the authors' seemingly narrow focus on the alleged under-use of opioid analgesics and their suggestion that more liberal use of opioids can solve the problem. We would strongly argue for a more balanced view when considering approaches to improving acute and chronic pain management.