Defining and Eliminating Pain

Defining and Eliminating Pain
June 18, 2020 No Comments Brave New World Apara Sharma

On a Scale from 1 to 10: The Ethical Implications of Defining and Eliminating Pain

By Eliza Lox

How do you define pain? Who decides how a patient’s pain is treated? Is it ethical for us to eliminate pain at all? How does the opioid crisis play a role in answering all of these questions? This paper will establish the definition of pain and take you throughout history to see how our point of view on pain, specifically in the United States, has changed with the opioid crisis and the role that pain currently plays in our society. It will also explore the topic through the lens of the ethical values of responsibility, nonmaleficence, autonomy, paternalism, empathy, and compassion. Most importantly, this paper will consider the role pain plays in “making us human” and how that should be considered in the decisions about pain treatment or elimination.


Table of Contents


Abstract

Last year I sprained my ankle and went to the nearby urgent care. When the doctor came in to examine me, the first question she asked was “how did the injury occur?”. However, the very next question, which surprised me, was: “On a scale from one to ten, how would you rate your pain today?”

I sat there for a few moments, unable to answer that question. It was the first time I had ever endured a semi-serious injury, one that I had to go to the doctor for, and I had no idea how to respond. It had not hurt as much as I thought a sprained ankle would have. However, compared to the physical pain I had endured thus far in my life, the pain was relatively severe and persistent. I knew that I had to use crutches and my ankle was very swollen, but that did not help me answer the question. I could rate this pain as an 8 today but consider it a 2 tomorrow. Another aspect I considered is that compared to people who have broken their ankle or had surgery, my pain was relatively low. How was I supposed to accurately answer that question for my doctor?

I have no recollection of my actual answer but it was most likely a three of four so as not to seem overly dramatic. Regardless of what  I said, I was instructed to regularly take Advil to reduce pain and swelling. That seems to be the world we are now living in; we rate our pain on a simple scale and then receive pills for treatment. 

I share this scenario to give a real-life personal example and set the stage for the questions that this paper strives to answer: How much pain should we have to be in to receive medical treatment? What should that treatment look like? Who gets to make that decision? This paper will establish the definition of pain and take you throughout history to see how our point of view on pain, specifically in the United States,  has changed with the opioid crisis and the role that pain currently plays in our society. It will also explore will explore the topic through the lens of the ethical values of responsibility, nonmaleficence, autonomy, paternalism, empathy, and compassion. Most importantly, this paper will consider the role pain plays in “making us human” and how that should be considered in the decisions about pain treatment or elimination. 


Physical vs. Mental

In order to evaluate the ethical implications, we must first define what category of pain we are evaluating.  In my research, I have found that there is, in fact, an overlap between mental and physical pain. For example, there was a story in the New York Times about a builder who stepped on a nail which went through his shoe and stuck out on the other side. The man was in excruciating pain so before treating his foot, the doctor gave him fentanyl and sedated him. When they removed the boot to take a look, they found that the nail had actually gone between his toes and never penetrated his foot.

“There are many studies that find that the fear or catastrophizing of pain contributes to a greater feeling of pain.”

– Frakt

This is similar to a concept from Dialectical Behavior Therapy, or DBT. In Marsha Linehan’s book entitled Cognitive-Behavioral Treatment of  Borderline Personality Disorder, she establishes the concept that pain is put upon us while we create suffering for ourselves. These are just a few of the many intersections between physical and mental pain that could be explored. Despite the overlaps, there are nuances involved with mental pain that I will not be able to explore in the scope of one paper.  For the purpose of this paper, I will be defining and addressing the ethical implications of physical pain.


How Does Pain Work?

First, we must look at the definition of pain from a biological lense. Physical pain is generally divided into nociceptive and neuropathic pain. In the case of nociceptive pain, nociceptors at the nerve endings can sense a range of acceptable and unacceptable levels of heat and pressure. When a noxious stimulus with heat or pressure that is outside of the accepted range is applied, electrical signals are fired through the nerves to the brain, which causes the body to react (Franks). For example, if someone were to place their hand above a fire, the heat would be within the accepted range and they would be able to feel the warmth of the fire. If they were to then stick their hand into the fire, their body would react, causing them to feel pain and pull their hand away. Similarly, someone who is holding a knife in their hand can feel that the knife is there but the pressure is light enough that their body does not react. If the knife were to then pierce the skin, nociceptors would sense that the pressure is outside of the accepted range and the body would react.

Nociceptive pain is further broken down by the part of the body in which they originate. Somatic pain, coming from the root word soma (meaning body), occurs when nociceptors in bodily tissues are activated. This includes most headaches and cuts. Visceral pain is when internal organs themselves become inflamed and is usually described as an ache such as menstrual cramps. Radicular pain occurs when the nerve root itself is irritated or damaged and often the pain spreads through the spinal column and is described as numbness or tingling (Franks).  For example, a herniated disk could pinch the nerve root and lead to radicular pain (Aligned Medical Group). 

On the other hand, neuropathic pain originates from the central nervous system itself and is when the neurological system is damaged. Although neuropathic pain is also the “shooting pain” associated with chronic illnesses such as multiple sclerosis, nociceptive pain can also be chronic. In order for pain to be considered chronic, it must last for at least 3-6 months and have a constant firing of neurons. Chronic pain has stumped scientists and doctors because it can only be temporarily relieved, not permanently eliminated. 

“One big difference between chronic conditions and acute illness is that a chronic condition generally requires life-long management…Even though pain may not be fully reversible, treatment can lessen its severity and allow you to enjoy a more vibrant life. It should also be said that it is not uncommon for an identifiable cause of pain to be discovered during a clinical evaluation, in which case your physician can offer treatment to help the underlying problem”

– Stanton-Hicks

Methods used to reduce chronic pain range from opioids to meditation to surgery. I will address some of these options later on in the paper. 

Understanding different types and categories of physical pain are necessary because pain is frequently treated based on its type or official diagnosis. In the case of somatic pain, it is common for doctors to recommend over the counter drugs while such medication is not effective for visceral pain since it is usually spread throughout the body (Duggal). Diagnosis and categorization is one way that pain can be somewhat standardized. 

However, people with the same medical diagnosis may experience a wide range of pain. For example, the diagnosis of bursitis shoulder pain ranges from very mild to severe. Mild cases can be treated with just over the counter medication, an ice pack, and shoulder stretching exercises. On the other hand, severe bursitis may require corticosteroid or even surgery to ease the pain (Nall). Due to the large range of severity of diagnosis, doctors may need to observe the patient’s ability and pain levels overtime before successfully treating a diagnosed medical condition. 

In this section, I have explored pain through a biological lens, separating it into its two main categories, neuropathic and nociceptive pain.

I began to discuss the nuances in determining pain treatment and how its biological function plays a role in the decision. However, there is more to pain than science.

The role of pain has fluctuated throughout human history and what has happened in the past comes together to form our perspectives and treatment of pain today.


The History of Pain

For thousands of years, philosophers, scientists, and ethicists alike have been striving to create a more accurate description of pain that goes beyond what physically and biologically happens in the human body. The definition is more nuanced than it may appear. For example, Merriam Webster Dictionary is a source that can be trusted for giving a straightforward definition of any word in the English language. The dictionary offers a few definitions of pain, the first and most comprehensible one being “ a localized or generalized unpleasant bodily sensation or complex of sensations that cause mild to severe physical discomfort and emotional distress and typically results from bodily disorder (such as injury or disease)”. However, that simple definition brings up a complex question: Can pain be described as discomfort? Or is it more than that?

Philosopher’s struggle to grapple with what pain really means was prevalent all the way back in Ancient Greece and their view of pain was very different than it is now. Aristotle himself described pain “as a passion of the soul, a behavioral drive triggered by excessive stimulation of any sense organ, [which] requires a very different neurobiological approach”(Cervero 11). His definition includes mental and emotional pain as well as physical pain by using the phrase “sense organs” in referring to the heart and mind. Additionally, the word passion gives pain a much more positive connotation than most doctors and philosophers would give it today. 

Looking forward to the 4th century AD, about 600 years after Aristotle’s time, came the emergence of cyrenaicism. The basic concept of cyrenaicism is that rather than seeking “transient delights [in their lives], avoidance of pain should be the main concern of the wise”(Funk & Wagnalls). This aligns much more closely with today’s fixation of eliminating and avoiding physical pain at all costs and provides a stark contrast to Aristotle’s positive outlook on pain. 

In addition to philosophers, doctors themselves have searched for definitions of pain that are all-encompassing rather than a purely biological. During the end of the 19th and the beginning of the 20th century, famous neurologist Sir Charles Scott Sherrington dedicated a large portion of his career to studying pain in order to synthesize a definition.  His initial definition was that pain is “the physical adjunct of a protective reflex”(Cervero 4), supporting the idea that pain is a necessary function of the human body created to protect it. He also added that “how and to whom we attribute this mental process [pain] depends on our social, religious and scientific beliefs, and the key word here is certainly belief”’(Cervero 3). This definition acknowledges the role religion may play in one’s understanding of pain’s true purpose and the individualistic nature of experiencing pain. Later on in his career, Sherrington concluded that “pain remains a biological enigma- so much of it useless a mere curse”(Cervero 16). I believe that this definition is completely pivoting from the idea that pain is necessary to say that pain is a curse. His transition gives us somewhat of a roadmap to how society may have come to fear pain. 

Around the same time as Sherrington’s experiments, Welsh neurologist Thomas Lewis also had a fascination with studying pain. In the end, he too was unsuccessful in coming up with a concrete definition:

 “Reflection tells me that I am so far from being able satisfactorily to define pain, of which I here write, that the attempt could serve no useful purpose… pain is known to us by experience and described by illustration”

-Lewis (Cervero)

This highlights the subjectivity that is central to one’s perception and how it is only truly known through experience. 

Overall, perspectives on pain have continued to evolve throughout recorded human history. From being considered necessary or positive to being an unnecessary enemy to be avoided at all costs, there has been a wide variety of opinions. Scientific professionals have created both concrete biological definitions and abstract subjective ones. With these nonspecific definitions and opinions about pain, we must now ask the question: how does the history of defining pain bring us to how pain is treated in our current healthcare system?

The Shift

In the 1970s, doctors were taught to use their patients’ pain to gauge the severity of their injury or illness. James D. Hudson of The Washington Post describes this in his article “Pain: Why we fear it. Why we shouldn’t” which he wrote for The Arkansas Gazette :

I was a third year medical student in 1976. My first clinical rotation was in general surgery. The chief resident explained that a patient’s abdominal pain was the most useful tool we had in distinguishing the life threatening condition of acute appendicitis from a more benign ailment such as stomach flu or constipation. He warned us not to treat that pain before the attending surgeon had a chance to place his hands on the patient’s abdomen. We were also encouraged to listen carefully to the patient’s experience of pain, the timing, the duration, and factors that made it worse or better”

– Hudson

Before the 1990s, doctors used pain as a tool to evaluate the state of a patient rather than something to be quickly eliminated.

 In pain management centers, patients would work with their doctors to figure out a way for them to get their lives back despite their pain rather than how to get rid of it. During this time, the pain relievers that were most commonly prescribed were very mild. Harsher drugs such as Percocet, an early form of oxycontin, were prescribed very rarely and only for those in extremely severe situations (Hudson). 

Then, Dr. Jack Kevorkian emerged and changed how doctors and patients alike thought about pain. Dr. Kevorkian was a medical pathologist who aided terminally ill patients in ending their lives by giving them lethal injections. His belief was that in injecting these people he was stopping the associated physical, mental, and emotional pain that comes with slowly dying. 

“[Dr. Kevorkian]argued that this was compassionate assistance for patients with intolerable suffering, igniting a national debate about the wisdom of ‘death with dignity.’”

– Hudson

He was eventually charged with second-degree murder of  130 people in 1999 but was released early after promising that he would stop assisting in patient’s deaths. His case was heavily televised, allowing the ideology of pain reduction and death with dignity to become a hot topic of discussion in both professional and unprofessional spaces. (Schneider). 

Additionally, the 1990s was the time period in which the internet became more accessible and commonly used. In 1991, the World Wide Web was introduced by Swiss programmer Tim Berners-Lee. This invention along with others, such as the browser Mosaic, allowed people to search for a wide array of information more efficiently than before. Throughout the decade, people became more accustomed to quickly accessing information and getting answers to their questions which contributed to the ideology of using a “quick fix” to solve a problem (History.com)

There is a correlation between these two phenomena and the shift in pain treatment. For example, Dr. Kevorkian was put on trial for the first time in May of 1994 (Schneider). The following year, the concept of using pain as the “fifth vital sign” was first introduced by the President of the American Pain Society, Dr. James Campbell, in his presidential address (Morone et al).  The concepts of painlessness from Dr. Kevorkian’s case and expediency from the Internet converged to create the want for a quick way to reduce one’s pain.  

Unfortunately, in the same decade, pharmaceutical companies declared that opioids were not addictive and there didn’t appear to be any harm in increasing their rate of prescription (National Institution on Drug Abuse). 

 “…the pharmaceutical industry took note, and in the mid-1990s began aggressively marketing drugs like OxyContin. This aggressive and at times fraudulent marketing, combined with a new focus on patient satisfaction and the elimination of pain, sharply increased the availability of pharmaceutical narcotics”

-Katz

At the time, doctors believed that opioids could only cause a pseudo-addiction, meaning that the patient had addictive qualities because they were under prescribed in the first place. As a result, doctors would prescribe higher doses of the pills. More recently, it has been found that opioids are in fact highly addictive and pseudo-addictions do not exist (Hudson). Similarly, patients would take large amounts of opioids prescribed by their doctors as a way to numb their pain. Eventually, they would need more and more of the pills to not feel the pain and would turn to their doctors for prescription refills. This created a vicious cycle that led to the crisis in opioid misuse and an increase in overdose rates.  During the 1990s, the belief that patients could not get addicted to opioids combined with the demand for an easy remedy to pain created a dangerous trust in these painkillers. 

We are now in the height of the opioid epidemic. According to the United States Department of Health and Human Services, in 2018 alone, 10.3 million people in the U.S. misused prescription opioids. As of July 1, 2019, the U.S. Census estimated that the total population of the United States was 328,239,523 meaning that with a slightly lower population in 2018, about 3% of the population misused opioids that year.

The invention, increased usage, and now an epidemic of opioids have redefined what it means to get rid of pain. Rather than working to manage pain, people can find an easy fix through medicine. Long term, their “quick fix” too often leads to addiction, showing the extreme harms that come with pain elimination.

In the 1990s there was a general shift in mindset in which pain became something to be quickly reduced or eliminated. This, combined with the misunderstanding that opioids are non-addictive, laid the foundation for the current opioid epidemic.


The Subjectivity of Pain

Before we fully explore the ethical questions, we must look at how we currently evaluate and treat pain in our society, specifically in the United States. The issue with pain, is that everyone has their own definition of it. This nuance is reflected throughout history, as I discussed earlier, with a wide variety of definitions and opinions. 

There is no standard for what it means to be in extreme pain or any pain at all because it is a completely individual experience, making it subjective.

For example, a person who has broken their leg may be less shaken up about getting a scrape rather than another person who has never undergone a serious injury. Additionally, people who have undergone natural labor and the delivery of a baby, considered to be one of the most painful experiences a person can go through, may feel that almost all other pain is insignificant. On top of that, some have a higher pain tolerance than others, their range of acceptable heat and pressure is wider than the average person’s.

In an attempt to numerically determine the pain level of their patients, doctors have created pain scales. When a patient enters a hospital, doctors will often hold up a scale that ranges from a yellow smiley face all the way down to a red crying face. Some have descriptions such as mild, uncomfortable, severe, or unbearable to more accurately get a reading from the patient. Some even include pictures of potential injuries or longer descriptions that read “interferes with concentration” or “bed rest needed” (South West Regional Wound Care Program). Once again, pain is subjective; what one may consider an “8” may be a “2” to another person. It can be caused by a variety of factors. This brings up the question: is it ethical to refuse a certain level of treatment to a patient for their pain if there is no standard way to determine how bad one’s pain is from one patient to another? 

Even our tendency to say “painkiller” rather than “pain reliever” is telling.

The most common form of treatment currently is painkillers. There are common over-the-counter pills, such as ibuprofen and aspirin, which work by binding to the active site of the enzyme which prevents arachidonic acid from binding and delivering the message. People are constantly taking these pills to reduce pain from headaches, cramps, or muscle aches. There are also more effective pills, such as opioids, that need to be prescribed by a doctor which will be addressed in more detail in the next section. Over usage of everyday pain medicine means we are numb to the “natural pain” that keeps us alive and are more reliant on pills to feel better. 

Health care systems also perpetuate the overuse of pain medication by easily covering the costs of them, doctors recommending them, and the specialization of pain management doctors. All of these contribute to the ideology that pain will be conquered by modern medicine. Additionally, we must acknowledge that chronic illnesses are treated differently and there is a stigma around them due to the subjectivity of pain. Patients, especially women and people of color, are unlikely to be believed about their pain before getting officially diagnosed. A study done in 2016 entitled “Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites”, found the following results:

“black patients were significantly less likely than white patients to receive analgesics for extremity fractures in the emergency room (57% vs. 74%), despite having similar self-reports of pain”  

Hoffman et al.

Pain scales are used as a way to standardize levels of pain however there continues to be subjectivity due to experiences and demographics. The subjectivity of pain is the central issue in our attempt to determine the justest and effective way to treat a patient in pain.


Who Decides How Pain is Treated?

The history of defining and treating pain as well as its subjective nature forces us to be faced with the question: Who makes the choice about how and to what extent pain is treated? 

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Role of the Patient- Grounded in Autonomy 

One potential way to answer this question is that the patient should have full autonomy over their course of treatment. They are the one experiencing the pain so they are the only one who knows its extent. However, since pain is subjective the patient would be likely to undertreat or overtreat their pain. If the person is addicted to painkillers, having little external regulation would be very dangerous. Therefore, it is necessary for another person to be at least somewhat regulating their treatment. 

Role of the Doctor- Grounded in Nonmaleficence and Paternalism

Another possible solution is that doctors could have the ability to choose how to treat their patient’s pain, which is closest to reality. The original Hippocratic Oath, written in Ancient Greece, inspired the bioethical principles of nonmaleficence and beneficence. These are principles that doctors promise to uphold and brings up the question about what truly is best for their patient. 

This applies to pain management and begs the question: What is the responsibility of doctors to treat pain? In other words, since doctors establish their patients’ level of pain when taking their vitals, can they allow their patients to continue to be in pain, even if it could potentially allow for the best long term outcome? For example, a patient goes into the ER with an injured leg. The doctor who is treating that person asks them to rate their pain while taking their other vitals. The patient answers that their pain is at a 7 meaning that it is moderate to severe and interferes with concentration. The doctor knows that prescribing opioids could help reduce the patient’s pain in the short term, but could also lead to addiction in the long term. Since the patient reported a high level of pain, the doctor has a certain level of responsibility to treat that patient’s pain. However, from my perspective, that does not mean that the doctor has a responsibility to prescribe strong painkillers.  By running tests, accurately diagnosing the leg injury, and restraining from prescribing addictive drugs, the doctor can find the most effective treatment and reduce the patient’s pain in the long term.

Furthermore, the Lasagna Hippocratic Oath, written in 1965, requires the doctor to promise: 

“I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.”

– Lasagna

In taking “all measures” that may include all measures to eliminate their patients’ pain. On the other hand, prescribing painkillers can be seen as overtreatment, therefore showing the hypocrisy in even one sentence of the Oath. 

Doctors have a responsibility to their patients through the Hippocratic Oath to do no harm but what does that truly mean? It can be viewed as treating the patient’s current pain or it can be viewed as allowing the patient to temporarily remain in pain in order to find a long-lasting cure and not risk them being addicted to painkillers.

Additionally, it can be difficult for doctors to determine the correct balance of pain medication to prescribe to their patients which can be a more long term solution.

The argument can also be made that allowing the patient to be in temporary pain is nonmaleficence or that doing so to find a cure is benevolence. The opposite can be said about intensely treating current pains. From a consequentialist lense, it is best to find a long term solution. However, it is ultimately up to the patient, their doctor, their family, and the healthcare system to decide how to treat a patient’s pain. 

There is a level of paternalism that comes with doctors deciding the course of treatment. It can be advantageous as the doctor has a strong medical background to figure out the best potential outcome. On the other hand, paternalism is also viewed as limiting the autonomy of the patient. I believe that the doctor can have paternalism to figure out the best treatment from a medical perspective but the patient should have the ultimate decision about whether or not to take the course of action. Also, doctors are often rated on how well they treated a patient’s pain, which can impact how much money they make or how they view their success as a physician. Therefore, a doctor who is rated could potentially prescribe pain killers to boost their rating.  Of course, addiction must also be factored into this decision. A study done in 2016, found that patients with musculoskeletal conditions who reported higher satisfaction with their care also were more likely to use opioids and often a large amount.

For example, Dr. Karen Rezach felt that the hospital where she had knee surgery was urging her to take painkillers:

“In June 2019, I had to undergo surgery to repair a torn meniscus in my knee. It was not major surgery, and the recovery time was expected to be a few weeks. Prior to the surgery, I was sent a prescription for a very potent pain medication to fill and have ready for any post-surgical discomfort. Additionally, on the day of the surgery while in the recovery room, I was offered a very strong pain medication. When I declined to take the medication because I was not experiencing any pain due to the effects of the general anesthesia, I was told that I was required to at least take extra-strength Tylenol. In the days following the surgery, I experienced very little pain or discomfort and never needed any additional pain medication, over the counter or prescription. Therefore, I returned the prescription pain medication to the pharmacy.”

-Rezach

Finally, since there is no accurate way to measure pain from person to person, the doctor will have to make assumptions and could also under or over treat. Based on the principles of nonmaleficence and paternalism, doctors can effectively treat their patient’s pain but there is still room for error because of their bias. 

Role of the External Structures- Based on the Standardization of Care

The last option is that a larger system such as the government, healthcare provider, or insurance company would have the ability to choose. If a government organization such as the Centers for Disease Control and Prevention created strict, explicit guidelines for the treatment of every type of pain and which painkillers can be prescribed this would mean that the entire United States would have more standardized care. There would not be a large disparity between the treatment of people in different states and with different doctors, making the system more just. In the case that the healthcare provider, such as an entire hospital or system of health care facilities, created such guidelines, that would unify the system but not the country as a whole. There could still be disparities from hospitals in different systems which could also cause accessibility issues. Lastly, if insurance companies only covered certain types of treatment for certain levels of pain or diagnosis, that would mean that all patients using that company would likely be treated similarly. However, this would further reveal the differences between private and public insurance companies in the United States and would bring up debates about how much control private insurance companies should be allowed to have. 

Although there are differences between these stakeholders, the benefits would be that there would be less room for bias and subjectivity from the patients or doctors. However, if the entity as a whole was biased, there would be an impact on a larger group of people.

The main issue is that with regulations there is a loss of connection between the person making the decision and the person who is being treated. Choosing yourself or with a doctor allows for more specialized care.

For example, people with the exact same medical diagnosis may have varying levels of pain due to other factors. If the government were to choose which diagnosis can be treated which way, patients with different levels of pain would be inequitably treated the same. This would also require a significant philosophical shift since our society currently functions on individualized medicine. 

Additionally, it is necessary to consider the extremes of pain. Some people are born with Congenital Insensitivity to Pain and Anhidrosis (CIPA), which means that they cannot feel physical pain. This results in serious injuries such as broken bones due to the fact that they do not feel when they are pushing their physical limits which can even result in death. This highlights how crucial pain is to our existence. On the flip side, people living with chronic pain have interruptions in their daily life due to their excruciating and constant pain. Although there is no physical threat to their body, the neurons of people with chronic pain are constantly firing to the brain to send a reaction. Seeing the two extremes of not having pain and having constant pain, how can we allow people to willingly eliminate their pain or live with their pain if they do not have too?


Should Pain Be Eliminated?

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Other than the ethical issues involved with choosing who should regulate main management is the issue of whether pain should be eliminated in the first place and how. As humans, we have a responsibility to stay true to our human nature. According to the Merriam-Webster Dictionary, human nature is  “the fundamental dispositions and traits of humans”. Based on their values, people have a wide variety of what constitutes the central traits that make us human. René Descartes, French mathematician, philosopher, and writer, provides the well-known concept of “cogito ergo sum”, I think, therefore, I am. This phrase says that the fact that we have a conscience to use reasoning and think about our existence is what makes us uniquely human and is the key part of our human nature (Newman). There is also a common discussion about whether people are naturally good or evil.

From my perspective, at the core of all of these definitions and debates is that pain is part of what defines the human experience and is part of our nature. 

The biological definitions prove that pain is a natural reaction used to protect us. When there is noxious stimuli, we feel pain so that our body knows to react and keep us safe. With that in mind, should we even be taking drastic measures to reduce our pain at all?


Conclusion

Overall, I believe that our society has an obsession with eliminating even the smallest level of pain. From a consequentialist lense, people are dying from the opioid crisis so it is not worth treating patients with opioids unless their level of pain will have severe long term effects to the patient. Since pain is subjective, this is a difficult task but we must work directly with the patient to determine how their pain plays a role in their life.

I also believe that pain can be beneficial in finding long term solutions and appreciating life.

For example, as I mentioned in my historical section, doctors used to use pain as a diagnostic tool. Eliminating one’s pain before using it to find a diagnosis can make the long term treatment less effective. I also believe that we need physical, mental, and emotional pain in our lives in order for us to grow and appreciate when we are feeling at peace. We have a responsibility to our human nature to sometimes experience pain since it is our alarm system and is a natural part of being human. 

I believe that doctors should get most of the autonomy in deciding the patient’s treatment with input from the patients but keeping in mind the risk of addiction. There are larger systemic problems that must be fixed, such as our view on pain, rating systems, and decisions of insurance companies that need to change. Additionally, the government or healthcare system needs to provide some regulations to keep doctors in check from their own biases. 

In terms of appropriate pain treatment, I would suggest looking into solving the long term issue and using natural, alternative medicine before turning to medication or opioids. 

In this paper, I addressed the questions of what is the definition of pain? Who decides how a patient’s pain is treated? Is it ethical for us to eliminate pain at all? How does the opioid crisis play a role in answering all of these questions?

At the heart of this paper is the idea that we must be more aware of our tendency to want to eliminate pain.

In addition to the dangers of opioid addiction is crucial for us to stay true to our human nature, which can be sacrificed in our endeavors to remove pain from our lives. Natural medicines include acupuncture, plants, meditation, and food cures. In using these types of treatment, you are improving your overall health and wellness as well as avoiding the risk of reliance on pain medication or addiction. However, I understand that in many circumstances, there is no cure and natural medicine is not effective. At that point, I believe that it is appropriate to talk to a doctor about pain medication and begin the journey of finding the correct combination of medication to allow you to live with your pain. 

Although this paper covered biology, history, subjectivity, and human nature, there are other aspects of pain that should be explored to expand the topic. One of these, as I briefly addressed, is the mental and emotional pain. Should we have the same standards for treating pain such as mental illness as we do treating chronic physical pain? How does the subjectivity change when the pain is mental or emotional? How do the intersections between physical and mental pain impact your opinions? Is mental pain required to be human?



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