The Ethical Issues Of The Undiagnosed Pain Scenario

Pain is an immanent aspect of life; it is protective, provoking innate survival mechanisms in response to a perceived threat. As such, it is often associated with extremes of emotion, designed to protect the individual during times of bodily stress (Savage, 2008). However, the underlying cause of such pain is not always readily elucidated. Devoid of objective measures or obvious underlying pathology, the physician is reliant on the patient’s perception of their pain to govern treatment. When such a pain management scenario is further complicated by clinical suspicion of substance abuse, especially in the setting of opioid analgesia, treatment is both medically and ethically complex (Novy, 2009). This case study attempts to address the†¦show more content†¦History and clinical examination were unremarkable. She was admitted and commenced on opioid pain medication with ability to self administer as required. The treating physician immediately commenced a litany of investigations, both invasive and non-invasive. Over the course of her two week admission, infection, malignancy, pregnancy and a spectrum of other conditions were similarly excluded as the cause of her discomfort. Ms CP’s medical records were eventually obtained from neighbouring hospitals, revealing multiple lengthy admissions for medically unexplained symptoms, following a childhood spent on the children’s ward due to chronic severe asthma. Multiple references to clinical suspicion of substance abuse were identified. Investigation into her social history revealed Ms CP to be unemployed, with her welfare payments having recently been ceased following a resolved back injury which occurred 2 years previously. Throughout her hospital stay, Ms CP was exceptionally helpful, providing detailed history to medical staff and volunteering in learning tutorials with medical students. She described the hospital as her â€Å"home† and spoke fondly of a childhood spent terrorising students and junior doctors while receiving treatment for her asthma. During comprehensive history taking and examination conducted by multiple health professionals, her descriptions shifted and evolved, often differing between healthcare providers and