The case sent shock waves through the media and medical journals. A Western Journal of Medicine editorial about the case was typical:
Another message to physicians implicit in these verdicts is that there is a standard of care for pain management, a significant departure from which constitutes not merely malpractice but gross negligence. Even if professional boards might not hold their licensees to that standard, juries will. With the implementation of the new pain standards by the Joint Commission for the Accreditation of Healthcare Organizations, which recognize the right of patients to the appropriate assessment and management of their pain, public expectations will likely increase exponentially.
Indeed they did. Scientific discourse about pain management was now hopelessly tainted by popular debate. An otherwise well appearing patient walking into the emergency department announcing pain at "10 out of 10" was an urgent indication for narcotics. Adverse effects of narcotics administered on the wards were minimized in importance.
Many of us who realized that the teaching about pain management was based more on dogma than science were worried about unintended consequences. This past year the adverse consequences have been brought to light. A JAMA news report earlier this year documents an alarming rising trend in narcotic related deaths which began in 1999, about the time the new pain management initiatives began to be promulgated. Our pain management dogma that "addiction is rare" was challenged by this systematic review of outcomes for opioid treatment of chronic back pain, which showed addictive behavior to be quite common. Thought leaders this year began to question the science behind the rise in opioid use, calling for the same standards of scientific rigor we apply to other treatments. Finally, a paper from the Journal of the American College of Surgeons earlier this year (H/T Aggravated Doc Surg) demonstrated that since the promulgation of recent pain management initiatives we have changed from a culture of undertreating pain to one of overmedication and underconcern for adverse effects of narcotics, resulting in patient deaths.
Perhaps 2007 will be remembered as the year of appreciation of the adverse consequences of pain treatment dogma.