Calculation, Comparison, and the Incommensurable: Balancing Risk in Pain Care

Pain is the most common reason for seeking medical care. Yet treating it is often fraught with uncertainty and a powerful sense of risk in American medicine, particularly in the context of the ongoing opioid crisis. Clinical consensus about the best way to manage many forms of pain remains elusive, and risks ramify beyond individual patients themselves to entangle clinicians and even society at large. The language of "balancing risk" often frames discussions-in both clinical decision-making and public policy-about whether to prioritize relieving pain or preventing addiction and whether to privilege individual or public health. This article takes up the notion of balancing risk to explore the way in which it embeds assumptions about commensurability of profoundly different forms and scales of risk, imagining that they can be calculated, compared, and brought into some kind of give-and-take alignment with one another. Thinking with a "dignity of risk" lens, however, suggests other possible frames, moving us away from such fictive calculations of risk in contemporary pain care and toward a more patient-focused clarification of risk.