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Pain, Pain Management and the Law
"Two sets of observations have been the strongest impetus for a critical reexamination of the evidence supporting the traditional view of opioid therapy. First, experience gained during the management of cancer pain has demonstrated the potential for highly favorable outcomes from long-term opioid therapy. Second, evidence has accumulated that the laws and regulations intended to reduce illicit use and misuse may have unintended adverse effects on legitimate prescribing. These observations provide a context for further analysis of the controversy surrounding the use of opioids for nonmalignant pain."
R.K. Portenoy Opioid Therapy for Chronic Nonmalignant Pain: Clinicians' Perspective 24(4) J. L., MED. & ETHICS 286 (1996) [HTML] [PDF]

"Health care professionals offer many reasons for the undertreatment of pain, and an effective response to the problem requires an effort on several fronts. Health care professionals require much more effective education and training in the treatment of pain. Institutions must remove unnecessary institutional barriers to pain relief and should ensure that effective pain management is an institutional priority. Payment systems should realize the costs of pain and adequately support pain control. Patients and caregivers must also be informed and assured that pain relief is to be expected and that fears of addiction are unfounded.
One source of the problem, according to physicians, is the threat of legal sanctions for treating patients in pain, especially when that treatment must rely on the use of controlled substances. Doctors have reported that they undertreat for pain, in part, from fear of legal penalties, especially disciplinary action.…"
Sandra H. Johnson, Disciplinary Actions and Pain Relief: Analysis of the Pain Relief Act, 24 J. L., MED. & ETHICS 319 (1996). [HTML] [PDF]

Additional Commentary
Phebe Saunders Haugen, Prescribing Opiates for Pain Relief, MINNESOTA MEDICINE, May 2000/Volume 83 [HTML]
Charles H. Wilson, Establishing the Right of the Terminally Ill to Adequate Palliative Care: The Litigation Alternative, J. OF PALLIATIVE MED., April 1999 [HTML]