Painful Reality: Inappropriate Provider Management of Pain as a Determinant of Health Care Avoidance

Although pain is often characterized as a subjective, highly individualized phenomenon, in fact, numerous elements which are simply biological in nature underlie interpersonal differences in pain experience that influence the effectiveness of provider pain management. Elements acting at the level of tissues and cells include signal-transmitting molecules in pain pathways; elements acting at the level of the whole person comprise entire brain networks and anatomic elements fostering pain vulnerability. However, knowledge of these elements and translation of such knowledge into practical means for relieving patient pain is dismayingly sparse across the total spectrum of health care professionals. A serious consequence of this knowledge and action gap is that isolated, or worse yet, repeated, pain experiences may lead to profound mistrust of the health care system and its providers and to health care avoidance (e.g., mammography). This article outlines a biologic knowledge base and proposed remedies to improve pain management across the entire domain of health care. Key components of this approach include enhanced education for providers and informational outreach to health care consumers, clarifying pain mechanisms to both constituencies. Moreover, increased accountability within the health care system is needed, both in knowing and applying well-established biomedical knowledge and in best using technical and interpersonal skills necessary for effective pain management.