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November 2015

Pain and Prejudice

Author Affiliations
  • 1Sedation Service, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
  • 2Harvard Medical School, Boston, Massachusetts
  • 3Pain Treatment Service, Department of Anesthesia, Perioperative, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
JAMA Pediatr. 2015;169(11):991-993. doi:10.1001/jamapediatrics.2015.2284

These are challenging times for clinicians who care for children and adults in pain. The general philosophy regarding the level of attention that should be paid to pain as well as its treatment has changed dramatically during the past 30 years, swinging wildly between extremes, and remains a moving target.

The first published recognition of pain undertreatment in adults occurred in the 1970s,1 with identification of similar and more dramatic concerns for children emerging a few years later.2 At that time, postoperative, procedural, and cancer-related pain were essentially ignored.3 Research documenting the short- and long-term negative consequences of poorly treated pain coupled with the development and marketing of new opioid compounds led to a dramatic increase in analgesia prescribing for essentially all painful conditions.4 The common opiophobia, in which excessive fears about addiction and narcotic adverse effects limited even their judicious use, gradually diminished for many physicians as numerous articles proclaimed the utility of these agents and as algorithms and consensus statements emerged to outline their safe administration.