Dr. Stahl presents on women’s pain panel at Conference on Medicine & Religion

Devan Stahl photoCenter Assistant Professor Dr. Devan Stahl recently attended the 2019 Conference on Medicine & Religion, held in Durham, NC. Dr. Stahl was part of a panel titled “”Ask Me about My Uterus:” Theological Responses to Women’s Pain in Contemporary Western Medicine.”

The three panelists, all women living with chronic pain or chronic illness, discussed their experiences dealing with pain, and the theological resources that have helped with that endeavor. Dr. Stahl discussed how the Desert Mothers provide models for understanding and handling pain in illness. Overall, the panel considered “how a theological re- narration of chronic pain might offer insight into the significance of women’s pain as well as resources for meaning-making in the midst of pain.”

Read more about this panel on the conference website.

Dr. Stahl and co-authors published in ‘Journal of Pain and Symptom Management’

Devan Stahl photoCenter Assistant Professor Dr. Devan Stahl is co-author of an article published in the February 2018 issue of the Journal of Pain and Symptom Management. “Addressing a Patient’s Hope for a Miracle” was written by Myrick C. Shinall Jr. (Vanderbilt University Medical Center Section of Palliative Care), Dr. Stahl, and Trevor M. Bibler (Baylor College of Medicine).

Abstract: Ill patients may make decisions to continue aggressive life-prolonging care based on hope for a miraculous recovery, and clinicians can find goals of care discussions with these patients extremely challenging. Thus, palliative care providers may be asked to help in these discussions. The concept of “miracle” can express a multitude of hopes, fears, and religious commitments. Effective, sensitive engagement requires the palliative care provider to attend to these variegated hopes, fears, and commitments. This case presents a typology of ways patients express hope for a miracle along with analysis of the motivations and beliefs underlying such hopes and suggestions for tailored responses by palliative care providers.

The full text is available online through Elsevier/Journal of Pain and Symptom Management (MSU Library or other institutional access may be required to view this article).

March webinar to address pain as a social construct

bbag-blog-image-logoPain But No Gain: Pain as a Problematic and Useless Concept?

Event Flyer

References to the human experience of “pain” are common, but those references are often ambiguous and vague. Such ambiguity creates conceptual and practical challenges, especially in the work of clinical ethics consultation. Conceptual challenges arise, for example, from the distinction between pain and suffering. Practical challenges arise from tensions between objective and subjective components of pain, and clinical ethical challenges arise in cases like Charlie Gard’s. Here, on the one hand, the court argued that Charlie was in such extreme pain and suffering, he should be allowed to die. Alternatively, others stated that we could not truly know about the experience of his pain, and that treatment therefore should be made available. While pain is a relevant clinical problem, it is also a social construct shaped by culture, environment and gender. These distinctions however get lost in a simple “pain” reference. With several clinical ethics scenarios, Dr. Eijkholt will ask if references to pain help us with anything, or if we should perhaps abandon pain as a “useless concept.”

March 14 calendar iconJoin us for Dr. Eijkholt’s lecture on Wednesday, March 14, 2018 from noon until 1 pm in person or online.

Marleen Eijkholt, JD, PhD, is and Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Obstetrics, Gynecology and Reproductive Biology at the Michigan State University College of Human Medicine. Dr. Eijkholt focuses on a wide range of Ethical, Legal and Social Implications (ELSI) in health care ethics, including neurotechnology, reproductive medicine, clinical medicine and clinical research. Her work is eclectic like her background, including projects on pain, placebos, and reproductive rights, or deep brain stimulation, and experimental treatments like stem cells. She combines ethical, legal and philosophical theories in her research and scholarship. Additionally, she engages these in her professional life as an ethics consultant at Spectrum Health System. Dr. Eijkholt also contributes her expertise to the College of Human Medicine’s Shared Discovery Curriculum.

In person: This lecture will take place in C102 East Fee Hall on MSU’s East Lansing campus. Feel free to bring your lunch! Beverages and light snacks will be provided.

Online: Here are some instructions for your first time joining the webinar, or if you have attended or viewed them before, go to the meeting!

Can’t make it? All webinars are recorded! Visit our archive of recorded lecturesTo receive reminders before each webinar, please subscribe to our mailing list.

Announcing the Spring 2018 Bioethics Brownbag & Webinar Series

green brownbag and webinar iconThis year’s Bioethics Brownbag & Webinar Series resumes in February. You are invited to join us in person or watch live online from anywhere in the world. Information about the spring series is listed below. Please visit our website for more details, including the full description and speaker bio for each event.

Spring 2018 Series Flyer

Feb 15 date iconWhat’s the point of Michigan’s vaccine waiver education requirement?
Are parents changing their minds as a result of mandatory vaccine education, or are they choosing to vaccinate rather than be inconvenienced by education sessions?
Wednesday, February 14, 2018
Mark Navin, PhD, is an Associate Professor of Philosophy at Oakland University.

March 14 calendar iconPain But No Gain: Pain as a Problematic and Useless Concept?
Do references to pain help us with anything, or should we perhaps abandon pain as a “useless concept?”
Wednesday, March 14, 2018
Marleen Eijkholt, JD, PhD, is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Obstetrics, Gynecology and Reproductive Biology in the Michigan State University College of Human Medicine, and Clinical Ethics Consultant at Spectrum Health System.

April 11 calendar iconEthical Issues Related to Fundraising from Grateful Patients
How should the process of philanthropic development be structured in order to demonstrate respect for all persons involved?
Wednesday, April 11, 2018
Reshma Jagsi, MD, DPhil, is Professor and Deputy Chair in the Department of Radiation Oncology, and Director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan Medical School.

In person: These lectures will take place in C102 (Patenge Room) East Fee Hall on MSU’s East Lansing campus. Feel free to bring your lunch! Beverages and light snacks will be provided.

Online: Here are some instructions for your first time joining the webinar, or if you have attended or viewed them before, go to the meeting!

Can’t make it? Every lecture is recorded and posted for viewing in our archive. If you’d like to receive a reminder before each lecture, please subscribe to our mailing list.

Dr. Eijkholt presents at 13th Annual International Conference on Clinical Ethics Consultation

Marleen Eijkholt photoThe 13th Annual International Conference on Clinical Ethics Consultation (ICCEC) was held on May 25-27 in Singapore. Center Assistant Professor Dr. Marleen Eijkholt attended and presented on a neuroethics panel, “A Cross Cultural Examination of Pain: Conceptual, Practical and Clinical Ethical Challenges.”

Pain is a relevant clinical problem, but also a social construct impacted by culture, environment, and gender. As a result, pain is perceived, framed and treated differently across cultures. However, minimal literature exists on cross-cultural examinations of pain.

Dr. Eijkholt and collaborators Nneka Sederstrom (U.S.), Daniel Fu-Chang Tsai (Taiwan), and Yonghui Ma (China) explored various challenges in the framing of pain across cultures. By focusing on a specific case, the panel examined the meaning of pain, the various challenges of the pain discourse, and the varying approaches toward pain through a cross-cultural lens. They delved into the ethical, legal, and social issues around pain. Asking: what is the relevance of pain in the clinical setting, what (in)abilities do patients and surrogates have to address pain in the clinical setting, how is pain treated, and what concepts frame the importance of pain, they sought to compare and contrast different approaches to draw lessons for working in a cross-cultural context.

Dr. Eijkholt also presented a case study titled “Clinical neuroethics: Cracking brains and health care systems.”

Overdosing on Prescription Painkillers: Dying for Pain Relief?

Bioethics-in-the-News-logoThis post is a part of our Bioethics in the News series. For more information, click here.

By Karen Kelly-Blake, Ph.D.

There has been much news coverage in the past few weeks regarding the increasing number of prescription painkiller deaths from opioid and narcotic pain medications such as Vicodin (hydrocodone), OxyContin (oxycodone), Opana (oxymorphone), and methadone (CDC Vital Signs). This trend is especially striking among women (CDC Vital Signs notes a 400% increase since 1999). Non-Hispanic white and American Indian or Alaska Native women have the highest risk of unintentional, suicide, and other deaths from prescription painkiller overdose. The Centers for Disease Control reports that “about 18 women die every day of a prescription painkiller overdose in the US, more than 6,600 deaths in 2010, and for every woman who dies of a prescription painkiller overdose, 30 go to the emergency department for painkiller misuse or abuse” (CDC Vital Signs). While men are still more likely to die of prescription painkiller overdoses (more than 10,000 reported deaths in 2010), women are closing the gap.

Several theories are posited to explain that gap, for example, women are: more likely to suffer from chronic pain than men; more likely to be prescribed higher doses and take painkillers for longer periods of time; and more likely to seek out multiple prescribers, i.e. “doctor shop” to get their prescriptions. Moreover, women typically have smaller body masses than men, and so the gap between a therapeutic dose and a fatal dose is narrower. The overall increase in painkiller deaths does not appear to be linked to a measurable increase in the kind of severe pain that would require prescription painkillers. Rather, the medications may be increasingly used to treat moderate pain (NY Times OP-ED). News coverage has focused on how to curb and monitor the apparent increased prescribing of these medications and how to educate patients about the risks of narcotic painkillers. What’s missing in the news coverage is how to deepen the conversation to speak to the issue of providing effective pain management for chronic pain sufferers.

In light of the new data about the troubling increase in painkiller deaths, how can healthcare providers effectively manage pain and simultaneously avoid under-treatment, misuse, and abuse of prescription painkillers? The CDC offers strategic advice on how to counter this growing problem, including tracking prescription drug overdose trends to better understand the epidemic, using prescription drug monitoring programs to identify patients who may be improperly using prescription painkillers, prescribing only the quantity needed based on the pain diagnosis, and improving access to mental health and substance abuse services through implementation of the Affordable Care Act (CDC Vital Signs). The CDC has spotlighted an important public health issue, and many agree that these strategies are reasonable and will go a long way to curb the epidemic. But one could also argue that in order to curb this newly identified epidemic we have to address another pressing public health issue: under-treatment of chronic pain.

Healthcare providers have failed to provide adequate pain relief. Barriers to providing pain relief include clinician fear (fear of patient abuse and addiction, diversion, and regulatory scrutiny), clinician failure in identifying pain relief as a patient care priority, and a clinician knowledge deficit in the assessment and management of pain (Tomlinson; Rich 2000). Under-treated pain results in a host of physiological, psychological, social and economic consequences ranging from reduced mobility and strength, disrupted sleep, depression and anxiety to difficulty working and lost wages (Brennan et al. 2007). Scholten et al. (2007) assert that 80% of the world’s population fails to receive pain relief when needed. To address this deficit, instead of narrowly focusing on potential abuse, they suggest implementing more balanced policies on opioid use so as to enable access to pain relief that would address human suffering. The optimal way to treat chronic pain is through a multidisciplinary pain clinic, using a team approach offering physical therapy, psychological support, and appropriate pain medications. Such facilities are rare, and not surprisingly, a significant number of chronic pain sufferers are from low-income groups. As such they commonly lack insurance to cover costs for this ideal model for pain treatment.

If we believe that relief of pain is a core ethical duty for medical professionals then in light of the barriers listed we have to find a way to advance that moral imperative. First, clinicians have to trust their patients’ reports of their pain. There is an abundant literature on trust between patients and physicians, focusing largely on whether patients trust their healthcare providers, yet a dearth of literature on the trust physicians have, or don’t have in their patients. To advance this agenda, providers would have to stop viewing their patients as potential drug abusers and dealers, discounting their pain. Second, clinicians would need to appreciate, or be taught to appreciate, pain’s capacity to seriously impair a patient’s quality of life. As Tomlinson suggests about pain, “it is a malignant force in and of itself, a fact clearly evident to most humans who have not had medical training if not to those so trained.” Third, clinicians would need to understand that under-treatment is poor medical practice (Brennan 2007). ’Doing no harm’ does not mean ‘do not treat’ or ‘under-treat because you are scared.’ It requires one to balance the benefits and risks of pain treatment strategies. These strategies would not mean resorting to painkillers first, or to painkillers alone, but instead would involve trying a variety of treatment modalities. Fourth, having balanced the risks and benefits, clinicians should respect patients’ autonomy to choose and reject treatments. This is not to suggest that physicians have to go along with a patient’s choice that is counter to his/her professional rights. What it does mean is that if the clinician has a professional objection, then he/she should provide the patient with information about accessing treatment elsewhere. Lastly, clinicians should demonstrate equal concern for all patients. When a patient presents with a pain complaint and wants help, and the clinician’s response is to be suspicious, to disrespect the pain report, and to underestimate the impact the pain has on the patient’s quality of life, that provider has violated the principle of equal concern. Such violations are more likely when the pain patient is female, African-American, Hispanic, or low socioeconomic status.

So if we are to make any inroads in the epidemic of painkiller deaths, then we have to address the equally compelling public health issue of under-treatment of pain. This would require addressing the barriers outlined here and repackaging the alleviation of pain as a moral imperative in medical practice. Unfortunately, as it currently stands, “the good of relieving pain is far too invisible/too little recognized” (Tomlinson). The absence of pain management as a healthcare priority is seen at every level of health care delivery. This is most evident in the lack of available National Institutes of Health funding for, or focused on, pain relief. Avoiding patient addiction and abuse, diversion tactics, and clinician self-protection are important parts of this conversation to be sure, but these issues cannot dominate the discussion. Understandably, clinicians may feel that they are walking a tightrope when it comes to pain treatment. They may feel they are in a “damned if they do and damned if they don’t” situation when prescribing painkillers, but as Johnson (2007) observes “unrelieved pain blocks enjoyment of all other human goods and values.” Thus the challenge is how to achieve the social and medical change that will make pain management a fundamental component of health care– for that most fundamental physician duty—to care attentively and equally for all patients.


list-cropKaren Kelly-Blake, Ph.D., Dr. Karen Kelly-Blake is a Research Associate whose research interests include health services research, medical shared decision-making, physician training, health disparities, and medical school curriculum development. She is a medical anthropologist and MSU alum. Karen also teaches in the CHM Social Context of Clinical Decisions courses.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Friday, August 9, 2013. With your participation, we hope to create discussions rich with insights from diverse perspectives.

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