Pain Management as a Fundamental Human Right

July 29, 2009

by Daniel Carr, M.D, FABPM, Founding Director PREP program Tufts University School of Medicine and Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
As the healthcare system has become more patient-centered, one sees increasing reference to patient rights to aspects of care, such as pain care. What does it mean for something — in particular, pain management
– to be a “human right”?
Do entitlements evolve into rights, or are rights something that have always existed but whose formal recognition may be slow to come? How is the human right to pain management operationalized within national legislative, judicial and regulatory systems, and healthcare policy? Dr Dan Carr, Founding Director of the PREP program, explores whether there is a fundamental human right to pain management in a comprehensive review available at
http://www.anesthesia-analgesia.com/cgi/reprint/105/1/205. Co-authored with two distinguished international authorities, this article was published in the official journal of the International Anesthesia Research Society along with an unprecedented four editorials including a very affirming one from the World Health Organization. Those with a deeper interest in this important topic may wish to read the white paper prepared by Human Rights Watch, available at http://www.hrw.org/sites/default/files/reports/health0309web_1.pdf .
What are your thoughts about pain managment as a fundamental human right? Please share your thoughts and comments.

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1 Comment Add your own

  • 1.    Donna Carrillo Lopez  |  November 23rd, 2009 at 4:16 PM

    As an RN who graduated from what was called the “mecca” or MGH at the beginning years of the 1970s, I went on to practice nursing in California and Texas as a multi-specialty RN. During this time period, I worked in those early years when NICUs lacked the monitoring technology that we have today. One afternoon during my shift, I was startled to see an attending physician insert a chest tube on an infant with no anesthetic nor pain modality. I confronted him and he told me that infants only felt “a generalized pain sensation and, besides, anesthesia and medication might compromise the infant”.
    The next day, an obstetrician came in to do circumcisions and again I asked this man if he used any pain modalities to lower the threshold for the infant’s procedural and after care pain. Again, I was told that local anesthetics could compromise the infant and no, there was nothing he could offer to the infant, except a pacifier.
    A decade later, I encountered a friend whose father was terminally ill in his last days. She told me that he had been in severe pain for many weeks and his visiting nurse and his attending doctor told his family that they didn’t want to see him addicted to opioids and that tylenol with codeine should help him. The man died an agonizing death, witnessed by his loving and helpless family.
    Because medicine and psychiatry have focused on the physical and mechanical attributes of disease which followed the old problematic Cartesian duality, little thought of the requisite love and compassion had been invested in training those clinicians attempting to treat pain.
    Today, millions of chronically ill Americans have become refugees from the subcontinent of allopathy, preferring the holistic approach that treats mind, body, and soul. Naturopathy, acupuncture, ayurvedics, homeopathy and herbal medicine have become the healing fields for many Americans and people worldwide. Indigenous people and populations of less developed economies throughout the world intuitively comprehend the energy level healing of both illness and the concomitant pain that occurs alongside it. Whether it is qi or chi or energy translated by Tibetans, Hindus, Iraqis, the concept is shared. Pain occurs when there is blockage within or trauma from without the body.
    The fundamental wisdom here is that clinicians can mitigate pain and increase healing whether by a compassionate, humane presence alongside alternative methodologies or temporary pharmacologics. The key in all human pain treatment will remain the effort of the loving, compassionate heart of the clinician. Acupuncture, ayurvedics, homeopathy, naturopathy are only effective in the hands of practitioners who have found this compassion for others in their hearts. And this, and no less than this, is healing and the treatment of pain at its best.

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