Individuality, Choice, and Paternalism in Pain Management

In 2020, when the International Association for the Study of Pain (IASP) redefined pain for the first time since 1979, the intention was to help clinicians and other stakeholders better understand not only that pain is a multifaceted, bona fide medical condition, but also to consider that as an experience, pain varies from individual to individual, can be diverse in its expression, and complex in terms of its impact on a person’s life. This chapter describes and discusses the IASP’s “new” definition in detail along with its ethical and clinical implications. Additionally, this chapter underscores the importance of offering people with pain tailored treatment choices and takes an in-depth look at several of those types of available options, including pharmacologic agents, restorative therapies, interventional procedures, behavioral treatments, and complementary and integrated treatments. Factors which may often constrain or negatively impact pain treatment selection are described, with a major focus on access to care, the benefits of a thorough risk assessment, stigma, and educational deficits of clinicians and patients. It is not uncommon for patients who are presented with a multitude of pain treatment choices to desire some degree of paternalistic direction from their healthcare professional, and be more interested in pain relief than shared decision-making. Different forms of paternalism are defined and categorized from both the clinical and ethical perspective, looking at the role paternalism can play in the clinician-patient relationship today.