All Ethics and Legal Articles

The Rapid Rise of Non-Opioid Pain Policies

Did you know that there is a policy in Delaware that prohibits insurers from imposing numerical limits on physical therapy and chiropractic care visits that might deter prescribers or patients from using those treatments rather than opioids?1 Or, that, in addition to the 33 states that allow the use of medical cannabis for the treatment of chronic pain (or at least certain pain

Reconciling the New HHS Opioid Tapering Guideline with CDC and State Policies

The US Department of Health and Human Services (HHS) released in October a Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics.1 In the new document, HHS emphasizes that “Opioids should not be tapered rapidly or discontinued suddenly due to the risks of significant opioid withdrawal.” National media portrayed the new guideline as

New ICD-11 Codes Set to Improve Pain Care in the Primary Setting

Changes in the ICD-11 will impact the way primary care providers (PCPs) classify and prescribe for chronic pain.

Can I Call Myself a “Pain Specialist?”

Who defines the role of pain specialists? Inside the legal requirements for practitioners.

When Opioid Prescriptions Are Denied

When opioid prescriptions are denied: how prescribers and pharmacists can create a working relationship.

Pain in the Courtroom: An Excerpt

In this excerpt, Akhtar Purvez, MD, provides a frank perspective on working to stay focused on the needs of the patient and the requirements of the law.

The Opioid Band-Aid: The State of Pain Pills, Congressional Bills, and Healthcare in the US

Disease management strategy can be likened to applying band-aids rather than addressing root causes of chronic pain, states author Heather Tick.

Authorities’ Use of Big Data May Harm—or Help—Your Chances of Investigation

A former prosecutor and current defense lawyer outlines how you may be at risk of investigation-and what to do.

How to Avert Government Scrutiny When Prescribing Opioids

Former prosecutors offer pain practitioners guidance on how to use their own "data mining."

What Opioid Shopping Means for Pain Practitioners

Identifying those at risk for opioid abuse, misuse, and diversion presents an increasing clinical concern.

Patient Communication & Opioid Prescribing in the New Year

New, legacy, and peri-operative patients with chronic pain warrant unique prescribing and treatment approaches.

What is the appropriate use of phone texting between physicians and patients?

Communicating between physician and patient using phone texting is appropriate so long as sufficient precautions are taken to protect privacy per HIPAA.

Lessons from the Murder Conviction of Dr. Hsiu-Ying “Lisa” Tseng

Lessons learned from the California doctor convicted of murder after prescribing deadly combination of medications.

New CDC Prescription Surveillance System Publishes First Report

Using prescription drug monitoring programs (PDMPs), states are trying to affect real changes in prescription drug misuse, abuse, and overdoses. The Prescription Behavior Surveillance System (PBSS) is designed to compile de-identified epidemiological data on misuse behaviors.

A Wake-Up Call From Under Anesthesia

Pain clinicians can take a lesson from a high-profile lawsuit—take time for yourself to avoid burnout and the “us vs them” scenario of high-stress practices.

National Pain Strategy—A Positive Step Forward

A group of pain specialists have been working behind the scenes for the past 5 years to develop a National Pain Strategy (NPS), the fruit of their labor is now available for public comment.1,2 Practical Pain Management applauds the work of the taskforce and their recomme

New Mexico’s Approach to Improving Pain and Addiction Management

States are increasingly playing a regulatory role when it comes to opioid medications to prevent opioid abuse and diversion. New Mexico's program emphasizes patient-provider relationship over regulatory "dosage thresholds."

Balancing State Opioid Policies With Need for Access to Pain Therapies

States are increasingly playing a regulatory role when it comes to opioid medications. Dr. Stephen J. Ziegler discusses balancing the needs of the state with the needs of chronic pain patients.

New York State Enacts New Law to Prevent Drug Diversion

New York State enacts I-STOP, which is designed to curb prescription drug diversion by requiring physicians to send all prescriptions electronically (e-prescribe).

Working With Law Enforcement and DEA

How one patient/doctor relationship spawned a interdisciplinary collaboration of clinicians and law enforcement members.

DEA and Doctors Working Together

Share the Risk model is an example of successful collaboration among interdisciplinary teams of clinicians and law enforcement to mitigate professional risks while improving patient care.

Editor's Memo: Keeping the Trust in Difficult Times

How to pain practioners keep patient trust during changing times: Affordable Care Act, insurance coverage changes, politics?

PROMPT Challenges PROP’s Petition

Dr. Jeffrey Fudin responds to Physicians for Responsible Opioid Prescribing (PROP) in this exclusive report from Practical Pain Management.

Board-certified Doctor Cleared of Criminal Charges for High-dose Opioid Prescribing

An interview with Jennifer Bolen, former Assistant US Attorney, about her role in clearing a doctor of criminal charges for high-dose opioid prescribing.

Compliance in Pain Patients: Balancing Need to Test With Need to Treat

John F. Peppin, DO, FACP, tackles the debate surrounding urine drug monitoring in pain patients.

Testing Positive for Marijuana in Urine

Question: What do you do with the patient who tests positive for marijuana on a urine test? Dr. Jennifer Schneider answers this Ask the Expert question.

Doctor Shopping

What are a doctor's legal obligations if he or she suspects a patient of doctor shopping? This Ask the Expert question is answered by a lawyer and an addiction specialist.

Reconsidering and Revising Evidence-Based Practice in Pain Medicine: Steps Toward Sustaining the Profession?

Article examines evidence-based medicine and how to put it into practice in the pain field.

The Moral Community of the Clinical Pain Medicine Encounter

This article addresses the moral community of the clinical pain medicine encounter.

Moral Virtue and the Pain Physician

A brief description of the moral virtue and the chronic pain physician. Includes discussion about agency, intentions, and actions of pain physicians.

Pain as Disease and Illness: Part Two

Article discusses what we know about the ethical system and pain should engage and direct the real-world applications of practice, research, and education.

On Knowing

Article describes the use of knowledge and intellectual virtues in practical pain management.

Pain Care at the End of Life

Article discusses how to preserve dignity with chronic pain patients for care at the end of life. Includes discussion of the nature of pain as well as the impact of pain.

On the Role of Primary Care Within a System of Integrative Multi-disciplinary Pain Management

Article discusses the role of primary care within a system of integrative multi-disciplinary pain management.

State Pain Laws: A Case for Intractable Pain Centers Part III

State intractable pain laws provide provisions for aggressive pain treatment while protecting doctors from unwarranted prosecution—provided that strict guidelines are followed.

Balancing Pain Management and Professional Risk

A discussion on how to provide adequate pain relief while avoiding potential legal complications in prescribing controlled substances.

Legal Landscape of Pain Treatment

On overview of the legal, regulatory, and ethical issues relating to pain treatment.

Pain and Addiction: Words, Meanings, and Actions in the Age of the DSM-5

Over the past years, I have focused this column on how the nature of pain—as a symptom, disorder and manifest illness—gives rise to both certain moral responsibilities of care and ethical, legal and social issues, questions and problems that affect the pain patient, clinician and profession and the practice of pain management.

Pharmacogenetics in Pain Care: Consideration of Economic Impediments and Ethical Imperatives

In his song, “No One is to Blame,” singer Howard Jones laments that “…insecurity is the thing that won’t get lost”.1 Given the ambiguities of illness and often tenuous technical and economic landscape of medical practice, many patients and physicians are faced with insecurity.

Diversity in Pharmacologic Treatment of Pain

Pharmacologic Pain Care— From Epistemology to Ethics Pharmacologic management of chronic pain remains problematic in that it often evokes questions and issues at the practical intersection of biomedical science, ethics and law.

Pain, Neurotechnology, and the Treatment-enhancement Debate

In chronic pain (intractable pain) management, protocols for the use of medical interventions should be frequently assessed, revised, and followed by reflective evaluation and prudent governance to establish guidelines and policies. Article discusses ethics of pain treatments.

Realizing the “Promise” of Pain Management and Palliative Care

Article includes a discussion of realizing the “promise” of pain management and palliative care. Considerations for practice, ethics, and policy are also highlighted.

Neurotechnology, Evidence, and Ethics

Article highlights neurotechnology, evidence, and ethics, including the stewardship and the good in research and practice for chronic pain.

Balancing Evidence, Efficacy and Stakeholder Values in Practical Pain Care

A New Year: Facing Durable Challenges and Tasks In this issue of Practical Pain Management, Prof. Peter Moskovitz addresses the complexities, issues, and problems that arise in, and from, the diagnosis and treatment of complex regional pain syndrome (CRPS).1 As Prof.

What a Decade of the Mind Affords the Decade of Pain Control and Research

Article gives an overview of a retrospective observational study of patients with unresolved wrist pain, which noted improvements in many quality of life parameters after Hackett-Hemwall dextrose prolotherapy.

Neuroscience, Neurophilosophy, and Neuroethics of Pain, Pain Care, and Policy (N3P3)

Article highlights neuroscience, neurophilosophy, and neuroethics of pain, pain care, and policy. Includes discussion of program, purpose, and process in pain management.

Intellectual and Moral Tasks in Intersection – Part 1

Assessing the experience of pain: making the subjective objectively appreciable.

Intellectual and Moral Tasks in Intersection—Part 2

Information, Consent, Autonomy, and Agency

Ethics, Pain Care, and Obama’s Policy Intentions

Essay on healthcare reform in America: As Congress continues to modify health care legislation in the Fall of 2009, they should (if not must) consider funding a deeper and wider scope of pain care options, including the apt use of new techniques and technologies and the re-constitution of multi-disciplinary pain care facilities.

Ethics, Education, and Policy: Relationship and Mutual Reliance

From Science and Philosophy to Ethics Over the past years, I have tried to illustrate how the problem(s) of pain, and intricacies of pain care, reflect profound philosophical issues and questions that are important to both the anthropologic applications of medicine, and the ethics necessary to navigate the moral terrain of medical practice.

Anticipating Biotechnological Trends in Pain Care

Biotechnological advances are changing how chronic pain patients are treated. Review developments in the pain field.

Pain Care of Severely Neurally-Compromised Patients

Practical and ethical considerations are discussed in this article in regard to pain care of severely neurally compromised patients.

The Experience of Pain

At the intersection of these two events—the current debate on health care reform and recent publications of evidence-based guidelines—author raises several questions about good healthcare and evidence-based medicine for chronic pain.

Neuroethics at the Close of the Decade of Pain Control and Research

Article discusses the changing views in neuroethics at the close of the decade for pain control and research.

Grappling with the Ethics of Practical Pain Management

Ethics is vital to the body of knowledge and skills that constitute medical practice. Article addressed the ethics of pain management.

Protecting Pain Physicians from Legal Challenges: Part 1

Sudden, unexpected deaths in opioid-treated chronic pain patients are an unfortunate—but not entirely unexpected—occurrence given the grave health issues these patients face; nevertheless, pain physicians should be aware of potential causes, take preventive actions and, if the unforeseen happens, be prepared to defend against legal challenges.

Culture and the Ethics of Patient-Centered Pain Care

Essay discussing the impact a patient's culture and background has on chronic pain management.

Protecting Pain Physicians from Legal Challenges: Part 2

This article presents a pain management specialist's perspective on how pain physicians can learn from others' mistakes and protect against legal challenges to their practice. Key article for the practicing pain physician to read.

Technology in Pain Medicine

Article discusses the role of research and new technologies in chronic pain treatments.

Confidentiality, Choice, and the Question of Autonomy

This article discusses patient confidentiality, a key issue in both research and medical practice. Patient choice and the question of autonomy is also discussed.

Chronic Pain and Substance Abuse

Substance abuse in the chronic pain setting is examined by an ethicist.

Pain Care for a Global Community: Part 1

Article on the ethical treatment of chronic pain patients worldwide, taking into consideration different societies' interpretation of pain.

Pain Care for a Global Community: Part 2

Part 2 of an article series on the global implications of pain management. How do we effectively treat chronic pain around the world?

Toward a Neuroethics of Pain Medicine

Pain medicine must continue to progress to meet the challenges posed by advances in scientific understanding and technology and ever-widening philosophical and ethical issues and imperatives arising from them.

Invoking the Placebo Effect

In addressing the mechanisms by which spiritual experiences and spiritual practices affect pain, it becomes apparent that these events engage pathways that can both modulate pain and initiate a var

Rational, Emotive, Ethical Approaches to Bio-psychosocial Pain Care

Article provides rational, emotive, ethical approaches to bio-psychosocial pain care. Includes discussion of the influence of Albert Ellis and rational emotive behavioral therapy on clinical bioethics.

The “Promise” of Pain Medicine: Profession, Oaths, and the Probity of Practice

This article includes a discussion of the “promise” of pain medicine, including a discussion of profession, oaths, and the probity of practice.

The Good Patient: Responsibilities and Obligations of the Patient-physician Relationship

This article discusses the good patient: responsibilities and obligations of the patient-physician relationship.

Clinical Bioethics: Pain and Psychopathology in Military Wounded

How Etiology, Epidemiology Sustain an Ethics of Treatment

Clinical Bioethics: Pain Research

The Relationship of Knowing and Doing

Clinical Bioethics

A Big Picture: Neurogenesis, Pain, and the Reality and Ethics of Pain Medicine

Clinical Bioethics

Resolutions: Examining the Past, Present and Future of Pain Management