Pain management and the goals of health care: Ethical and legal considerations

The phenomenon of systematically undertreated pain that has been copiously documented in the clinical literature over the last quarter century stands in marked contrast to this historical identification of the relief of suffering as one of the core values and primary goals of health care. The widespread undertreatment of pain also indicates a significant disparity between the curative priorities of the prevailing model of patient care and the palliative expectations of the lay public. The reasons commonly offered for the undertreatment of pain-characterized as the 'barriers' to the provision of effective pain management-are inadequate to justify the abandonment of this fundamental goal in patient care. New initiatives to improve the knowledge, skills and attitudes of health care professionals may collectively have the potential to transform the culture of pain that has for too long prevailed in the health care setting.