PainLink News Vol.1, No. 1: What's Going On-Line?

Vol. 1, No. 1	Summer, 1996

PainLink, a community of healthcare leaders committed to alleviating pain, is an initiative of Education Development Center, Inc. made possible through the guidance and financial support of The Mayday Fund.

What's Going On-Line?

Judy Spross

"I teach physicians, and I work with an interdisciplinary team on ethical issues. A common issue here is that nurses wish to medicate dying, unresponsive patients with morphine to treat tachypnea and tachycardia. Many physicians reply that the patient is not suffering and the nurses are threating themselves or the families. How do you respond to these concerns?"

--Muriel Gillick, M.D., on-line participant,
Hebrew Rehabilitation Center for Aged

Our listserv has been a hubbub of conversation since its start up. We launched the Mayday PainLink email list on May Day for the purpose of creating a place for dialogue on important issues and dilemmas in mobilizing for effective pain management. It is a place for professional sharing of our questions, resources, strategies, expertise and engaging in collaborative problem solving. The real value comes from participating, and we hope to demonstrate the value of the process and entice you to join, if you haven't already!

Use of Placebos

Whether or not placebos have a place in pain management and what are the ethical uses was raised early on by Lynn Jett's query, "Do you think the use of placebos for pain management (without patient permission) is ethical?" After some discussion, which included beliefs and opinions such as "Placebos without patient permission is abhorrent to me" as well as references to Loma Linda's policy of procedurally outlawing the practice, I responded, "I have the same understanding regarding placebos - that it is unethical to administer them without engaging the patient in a discussion of why placebos may be used and what would be accomplished..." Our discussion, based on clinical experience and scientific literature, suggests that placebos have no appropriate role in the diagnosis and management of clinical pain. However it is still an ongoing discussion and we welcome divergent points of view and other reports based in experience. Institutions may want to develop a policy about the use of placebos. We have attached a list of references provided by Karen Kaiser.

Respiratory Distress (Air Hunger) in Terminally Ill Patients

Muriel Gillick described a problem of trying to treat respiratory distress. Karen Kaiser responded, " Air hunger can be a panicky experience that is well treated with opioids. However the percentage of patients with air hunger is small. Please describe the phenomenon further." The discussion that followed has included participants' experiences in using opiates, scopolamine and other interventions. We are interested in hearing any practices and policies you use or questions or references you can offer.

Pain Management and Substance Abuse

Ira Mintzer suggests, "I think it would be terrific to have a case specific dialogue around a difficult case of substance abuse and pain management." Discussion has included questions on the best ways to manage a person on methadone maintenance which brought out divergent points of view: increasing methadone was one approach, separating pain management by morphine from treatment for substance abuse. This is a subject we will devote a couple of weeks to in the fall, bringing some national experts on-line to dialogue with us. In the meantime, we'd like to have the benefit of your knowledge.

Tell Us What You're Doing Differently

We are most interested in hearing any ways that participating in this discussion affects the way you think about and conduct your day to day practice. Let us know how you or your institution are changing!

Join Us!

We are interested in thoughts and references on placebos, treating air hunger, pain management and substance abuse, and a host of other topics which, if you are thinking about, someone else probably is, too. A topic is discussed as a conversation thread, and does not need to ever be completed as we continually work to increase our effectiveness and knowledge of this effort. We welcome new participants to the email list. If you are ready to join us, send an email to dmatulis@edc.org so that she may add you to the listserv.

References regarding placebos
Annie Fox, "Confronting the Use of Placebos for Pain," AJN, 94 (9): 42-46.
R.S. Shapiro, "Liability Issues in the Management of Pain, " Journal of Pain & Symptom Management, 9 (3): 147.
AHCPR Cancer Pain Guideline, p. 69.
American Pain Society, Principles of Analgesic Use in the Treatment of Acute and Cancer Pain. Skokie, Il: American Pain Society. (see p. 25.)
Gerald Gray and Patrick Flynn, "A Survey of Placebo Use in a General Hospital," General Hospital Psychiatry, 1981, 3:199-203.
H.K. Beecher, "The Powerful Placebo," JAMA, 1955; 159:1602-1606.
H.K. Beecher, "Surgery as Placebo," JAMA, 1961;176: 1102-1107.
F.J. Evans , "The Placebo Response in Pain Reduction," In J.J. Bonica, ed. Advances in Neurology, vol. 4, NY: Raven, 1974, pp. 289-296
N.L. Schecter, B.A. Berstein, A. Beck, L. Hart, L. Scherzer, "Individual Differences in Children's Response to Pain: Role of Temperament and Parenteral Characteristics," Pediatrics, 1991; 87: 171-177.

Last Updated: April 18, 2000