Socially Deconstructing Emergency Provider Perspectives and Chronic Pain

Alison Houchin

Social consideration of provider practice and the relationship that forms with patients diagnosed with chronic pain has historically been considered within the biomedical ethics paradigm. The provider considers the principle of beneficence, recognizing the obligation to provide care that benefits the patient and promotes good. Additionally, providers are faced with treatment options that have the ability to do harm. This principle of non-maleficence is also part of the ethical practice of chronic pain management. Pair the principles of beneficence and nonmaleficence with social construction and a complex equation governed by biomedical ethics and societal values (social construction) is formed. This concept is considered within the domain of emergency medicine. Prescription drug-related Emergency Departlnent (ED) visits are on the rise, as are morbidity and mortality injuries associated with prescription drugs. ED visits and unintentional overdoses related to prescription substance abuse are on the rise. The ED is intended for the treatlnent of acute conditions and, like primary care services, lacks the resources for the management of chronic pain. In 2009, the American Academy of Pain Management provided recommendations on the treatment of pain: 1) treatment would be provided solely by a single practitioner or clinic; 2) narcotic use should be limited to circumstances where it enhances function at work and horne; 3) escalating use or seeking opioids from multiple providers should prompt evaluations of the patient's opioid use and consideration to discontinue opioid therapy (Chou, et. aL 2009). Based on the above recommendations, the truth of what providers know, and what they see in clinical practice, are the socially constructed impetuses that drive the need for robust, multidisciplinary research and treatment of chronic pain. It is hypothesized that a care coordination approach to pain management in the ED is a novel program that coordinates ED care. An example is Providence Sacred Heart Medical Center (PSHMC), Consistent Care (consistentcare.com). Further research is required to enhance efforts to provide multidisciplinary chronic pain management. Perhaps Consistent Care is a model management approach that can he replicated and implemented in EDs nationwide. Pain is more than a physiologic event. It involves social concern and the well-being of the physical, psychological and spiritual domains. It is social concern that drives an analysis of historical perspectives related to pain and pain management, prescriber attitudes, and consistent care models. The principles of beneficence and non-maleficence, social construction and the complex equation involving biomedical ethics and societal values will be considered within the setting of emergency medicine.

Socially Deconstructing Emergency Provider Perspectives and Chronic Pain

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