Current Pain and Headache Reports

, Volume 16, Issue 1, pp 1–8 | Cite as

Ethical Challenges and Interventional Pain Medicine

  • Gary J. Brenner
  • Karsten Kueppenbender
  • Jianren Mao
  • Jeffrey Spike
Invited Commentary

“The relief of suffering and the cure of disease must be seen as twin obligations of a medical profession that is truly dedicated to the care of the sick. Physicians’ failure to understand the nature of suffering can result in medical intervention that (though technically adequate) not only fails to relieve suffering but becomes a source of suffering itself.”

—Eric J. Cassel [1]

We must abandon those orientations that treat pain as an object independently of the being that it affects.

—Giordano and Schatman [2]

Early in their professional careers, virtually all physicians endeavor to practice medicine in an ethical manner motivated by a desire to help patients. It is also clear that a significant proportion of individuals and organizations involved in the delivery of health care in this country are centrally motivated by financial concerns. Our fee-for-service reimbursement system compensates for “doing things” to patients. Because of this, great attention must be applied to assure...


Professionalism Medical ethics Anesthesia ethics Fee-for-service medicine Interventional pain practice Evidence-based medicine Ethical principles 



The authors wish to thank James Rathmell for his input.


No potential conflicts of interest relevant to this article were disclosed.


  1. 1.
    Cassel EJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982;306:639–45.PubMedCrossRefGoogle Scholar
  2. 2.
    Giordano J, Schatman ME. A crisis in chronic pain care: an ethical analysis. Part three: toward an integrative, multi-disciplinary pain medicine built around the needs of the patient. Pain Physician. 2008;11:775–84.PubMedGoogle Scholar
  3. 3.
    Levy RM. Differentiating the leaves from the branches in the tree of neuromodulation: the state of peripheral nerve field stimulation. Neuromodulation. 2011;14:201–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Mironer YE, Hutcheson JK, Satterthwaite JR, Latourette PC. Prospective, two-part study of the interaction between spinal cord stimulation and peripheral nerve field stimulation in patients with low back pain: development of a new spinal-peripheral neurostimulation method. Neuromodulation. 2011;14:151–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Yakovlev AE, Resch BE, Yakovleva VE. Peripheral nerve field stimulation in the treatment of postlaminectomy syndrome after multilevel spinal surgeries. Neuromodulation. 2011.Google Scholar
  6. 6.
    Frey ME, Manchikanti L, Benyamin RM, Schultz DM, Smith HS, Cohen SP. Spinal cord stimulation for patients with failed back surgery syndrome: a systematic review. Pain Physician. 2009;12:379–97.PubMedGoogle Scholar
  7. 7.
    Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, et al. The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation. Neurosurgery. 2008;63:762–70. discussion 770.PubMedCrossRefGoogle Scholar
  8. 8.
    Manca A, Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, et al. Quality of life, resource consumption and costs of spinal cord stimulation versus conventional medical management in neuropathic pain patients with failed back surgery syndrome (PROCESS trial). Eur J Pain. 2008;12:1047–58.PubMedCrossRefGoogle Scholar
  9. 9.
    Gilron I, Bailey JM, Tu D, Holden RR, Jackson AC, Houlden RL. Nortriptyline and gabapentin, alone and in combination for neuropathic pain: a double-blind, randomised controlled crossover trial. Lancet. 2009;374:1252–61.PubMedCrossRefGoogle Scholar
  10. 10.
    Thernstrom M. The pain chronicles. Farrar, Straus and Giroux, New York. xii, 364 p. pp.; 2010.Google Scholar
  11. 11.
    Shapiro J. Walking a mile in their patients’ shoes: empathy and othering in medical students’ education. Philos Ethics Humanit Med. 2008;3:10.PubMedCrossRefGoogle Scholar
  12. 12.
    Epstein RM. Mindful practice. JAMA. 1999;282:833–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302:1284–93.PubMedCrossRefGoogle Scholar
  14. 14.
    Kenny NP. Ethical implications of human suffering. Hum Health Care Int. 1997;13:27–30.PubMedGoogle Scholar
  15. 15.
    Cole TR, Carlin N. The suffering of physicians. Lancet. 2009;374:1414–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Rich BA, Dubois M. Pain, ethics, and public policy. Pain Med. 2011;12:1295–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Manchikanti L, Singh V, Boswell MV. Interventional pain management at crossroads: the perfect storm brewing for a new decade of challenges. Pain Physician. 2010;13:E111–140.PubMedGoogle Scholar
  18. 18.
    Giordano J. Techniques, technology and tekne: the ethical use of guidelines in the practice of interventional pain management. Pain Physician. 2007;10:1–5.PubMedGoogle Scholar
  19. 19.
    Giordano J, Schatman ME. An ethical analysis of crisis in chronic pain care: facts, issues and problems in pain medicine; Part I. Pain Physician. 2008;11:483–90.PubMedGoogle Scholar
  20. 20.
    Giordano J, Schatman ME. A crisis in chronic pain care: an ethical analysis. Part two: proposed structure and function of an ethics of pain medicine. Pain Physician. 2008;11:589–95.PubMedGoogle Scholar
  21. 21.
    Schatman ME. Ethical issues in chronic pain management. Informa Healthcare, New York. xiv, 312 p. pp.; 2007.Google Scholar
  22. 22.
    Gosden T, Forland F, Kristiansen IS, Sutton M, Leese B, Giuffrida A, et al. Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians. Cochrane Database Syst Rev CD002215; 2000.Google Scholar
  23. 23.
    Hennig-Schmidt H, Selten R, Wiesen D. How payment systems affect physicians’ provision behaviour—an experimental investigation. J Health Econ. 2011;30:637–646.Google Scholar
  24. 24.
    Schofferman J. Interventional pain medicine: financial success and ethical practice: an oxymoron? Pain Med. 2006;7:457–60.PubMedCrossRefGoogle Scholar
  25. 25.
    Provenzano DA. Diagnostic discography: what is the clinical utility?. Curr Pain Headache Rep. 2012 (this issue).Google Scholar
  26. 26.
    Wilkinson IM, Cohen SP. Epidural steroid injections. Curr Pain Headache Rep. 2012 (this issue).Google Scholar
  27. 27.
    Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine (Phila Pa 1976). 2009;34:1078–93.CrossRefGoogle Scholar
  28. 28.
    Armon C, Argoff CE, Samuels J, Backonja MM. Assessment: use of epidural steroid injections to treat radicular lumbosacral pain: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2007;68:723–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Rathmell JP, Manion SC. The role of image guidance in improving the safety of pain treatment. Curr Pain Headache Rep. 2011. doi: 10.1007/s11916-011-0241-z.

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Gary J. Brenner
    • 1
  • Karsten Kueppenbender
    • 2
    • 3
  • Jianren Mao
    • 4
  • Jeffrey Spike
    • 5
  1. 1.Department of Anesthesia, Critical Care and Pain Medicine, Center for Pain MedicineMassachusetts General HospitalBostonUSA
  2. 2.Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General HospitalBostonUSA
  3. 3.Department of PsychiatryMassachusetts General HospitalBostonUSA
  4. 4.Department of Anesthesia, Critical Care and Pain Medicine, Center for Pain MedicineMassachusetts General HospitalBostonUSA
  5. 5.The McGovern Center for Humanities and EthicsUniversity of Texas Health Sciences Center at HoustonHoustonUSA

Personalised recommendations