Departments of Psychiatry and Behavioral Sciences.
Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
Clin J Pain. 2021 Oct 26;38(1):58-63. doi: 10.1097/AJP.0000000000001000.
The claim of a right to pain relief was made in recent decades by pain professionals, courts, and patient advocacy groups and likely contributed to increased opioid prescribing, overdose deaths, and addictions, but the origins and nature of this right have not been investigated.
Relevant clinical, ethical, and legal literature concerning patient rights to pain care was reviewed.
The record describes the effort to improve end-of-life and cancer pain care in the 1980s and 1990s, which simultaneously legitimated pain relief as an independent goal of medical care and opioids as a safe and effective means to achieve this relief. In 1997, the US Supreme Court denied the right to assisted suicide but affirmed a right to palliative care to prevent dying in overwhelming pain. Other guidelines and regulations extended this right to pain relief from end-of-life care to chronic pain care, along with the titrate-to-effect principle, which specified that the correct opioid dose was the dose that relieved pain.
The most important consequence of combining the right to pain relief with the titrate-to-effect principle was the idea that a high pain score must not be ignored. This extension of the right to pain relief neglected important differences between end-of-life care and chronic pain care including: time frame, clinical setting and context, target of titration, and nature of iatrogenic harms. To help end our current opioid epidemic and prevent a future epidemic, we need to demedicalize pain and reintegrate it with the rest of human suffering as an experience connected to other personal behaviors and meanings.
疼痛专业人员、法院和患者权益组织在最近几十年提出了缓解疼痛的权利主张，这可能导致阿片类药物处方增加、过量死亡和成瘾，但这一权利的起源和性质尚未得到调查。
回顾了有关患者疼痛护理权利的相关临床、伦理和法律文献。
记录描述了 20 世纪 80 年代和 90 年代努力改善临终关怀和癌症疼痛护理的情况，这同时使疼痛缓解成为医疗保健的一个独立目标，并使阿片类药物成为实现这一缓解的安全有效的手段。1997 年，美国最高法院否认了协助自杀的权利，但肯定了在无法忍受的疼痛中进行姑息治疗的权利。其他指南和法规将这一权利从临终关怀延伸到慢性疼痛护理，以及滴定至有效原则，该原则规定正确的阿片类药物剂量是缓解疼痛的剂量。
将缓解疼痛的权利与滴定至有效原则相结合的最重要后果是，高疼痛评分不能被忽视。这种对缓解疼痛权利的扩展忽视了临终关怀和慢性疼痛护理之间的重要区别，包括：时间框架、临床环境和背景、滴定目标以及医源性伤害的性质。为了帮助我们结束当前的阿片类药物流行并防止未来的流行，我们需要使疼痛去医学化，并将其与人类其他痛苦重新整合，将其作为与其他个人行为和意义相关的一种体验。
