A world of pain

Pain is oddly subjective and universal. Although you may sympathize, you cannot literally 'feel my pain.' It's mine. But everybody, regardless of historical period or culture, knows what pain feels like: it hurts. And in hurting, it debilitates. Pain has been installed in us (and other sentient beings) for good evolutionary reasons: we need to know when our bodies are damaged. But, unfortunately, pain is a crude messenger. Pain often continues on, and even increases in strength, when we have already long got the point.

The journal Anesthesia and Analgesia is not exactly daily fare of the average bioethics worker, but the July issue contains a number of fascinating articles about the ethics of pain management. One striking consideration is the unequal global distribution of untreated pain. Pain may be universal, but access to pain management is certainly is not: if you suffer from chronic or acute pain, you are better off being Austrian than African. The former stands a good chance of getting opiate or non-opiate treatments; the latter is more likely to have to bite the bullet. And given the HIV/AIDS epidemic, the effects of war, poor sanitation, and the effects of treatable (but not treated) diseases, there may be just more pain needing treatment -- and not getting it -- among poor countries.

While there is distributive injustice in untreated pain between rich and poor countries, the undertreatment of pain is a worldwide phenomenon. Contributors to Anesthesia and Analgesia tackle explanations of the undertreatment of pain, what is ethically wrong about the status quo, and what to do about it. There seems to be a consensus that legal and political pressures (remember the 'war against drugs'?) about potential drug abuse and addiction have hindered aggressive pain treatment by clinicians, even in better-off nations. There are also cultural barriers, such as the belief that pain is natural and inevitable, or that it is a sign of a strong moral character to bear pain than have it relieved. Authors work both sides of the ethical street, arguing that appropriate pain management should be regarded as a human right while also documenting the social and economic consequences of untreated pain.