Defining chronic pain ethics.

OBJECTIVE To identify current issues in the diagnosis and treatment of chronic pain. DESIGN Focus groups were convened to discuss the current issues in chronic pain care. Commentary was analyzed across focus groups using an interpretivist method of qualitative data analysis. Setting.  Focus groups were held in five major US cities throughout the United States. PARTICIPANTS Key stakeholders working and thinking about the issues surrounding chronic pain, including people with pain, providers, insurance and pharmaceutical industry representatives, law enforcement agents, and advocacy groups. OUTCOME MEASURES Qualitative data was analyzed to determine if consensus regarding the current issues in the diagnosis and treatment of chronic pain exist. RESULTS Six major themes emerged regarding chronic pain, all of which contained an ethical component: 1) reducing disparities in access to pain care among the young, elderly, and lower socioeconomic groups, 2) defining quality of care in pain management, 3) the need to train qualified providers and training programs in pain medicine, 4) the need for evidence-based public policy regarding opioid use and diversion, 5) the need to raise awareness about chronic pain as a disease to prevent stigmatization and discrimination, and 6) promotion of multimodal therapies for pain care as a way of diverting attention from opioid abuse problem. CONCLUSIONS There is nationwide consensus among those holding a stake in the diagnosis and treatment of chronic pain regarding the ethical issues that must be addressed. Raising awareness about chronic pain, improving access and outcomes to quality pain care, and resolving public policy debates about the use of opioids in chronic pain populations are the first steps to ensuring a morally justifiable approach to chronic pain management in the 21st century.