ABSTRACT

Pain is a totally subjective experience influenced by many factors. Therefore, the evaluation of a chronic pain patient requires a multidisciplinary approach, with the understanding that one factor may produce different responses in different individuals. These factors include the perception of pain, the resulting disability from the pain, the use of medication, the presence or absence of litigation, the pre-existing psychopathology of the patient, the resultant psychiatric problems produced by chronic pain, the skill of the physician involved in the care of the patient, family issues, financial issues, and social issues. All these factors are associated with ethical quandaries, with the ability of the physician to practice chronic pain management often limited by forces beyond the physician’s control. The purpose of this chapter is to look at the importance of accurately diagnosing and confirming the diagnosis of the chronic pain patient, looking at some of the evidence supporting the importance of doing so—not just for the patient and the physician, but for the insurance industry as well. While a discussion of all of the existing impediments to the provision of the highest quality of chronic pain management is beyond the scope of this chapter, some of the crucial impediments with which the practitioner is faced are examined.