What Is Legitimate Pain?
/By Dr. Forest Tennant
The question posed by the headline of this article may at first seem ridiculous or unneeded. But a definition of “legitimate pain” is really needed.
Federal government regulations require physicians to get a DEA license to prescribe opioids and other controlled substances. The prescribing must be for a “legitimate medical purpose” -- which is obviously intended to mean legitimate pain.
It may be surprising, but the federal government doesn’t have a definition for legitimate pain. State medical boards throughout the United States also do not define legitimate pain, although they monitor physicians for the “legitimacy” of their treatments.
Recent history has shown that many physicians have been investigated and prosecuted for prescribing opioids without a “legitimate medical purpose,” despite the fact that there is no written definition of legitimate pain to be found in medical regulations and guidelines.
The lack of a written definition of legitimate pain has allowed wide discretion and abuse by prosecutors and their hired medical consultants, making it difficult for doctors to defend themselves against a system that is seemingly rigged against them.
Government agencies, medical boards, professional groups, and insurance plans also call pain “illegitimate” if they don’t like the treatment, dosage, brand, doctor, or cost.
As unbelievable as it may sound, I’ve read and heard some terribly biased and ignorant definitions of what is and isn’t legitimate pain.
For example, I’ve heard that a simple need for opioids makes pain illegitimate. The new definition of pain, according to some physicians, is really “opioid use disorder,” which requires treatment for addiction. I’ve also read that pain is a character deficiency and a natural part of life that needs no treatment.
There are some well-meaning persons who claim that pain is whatever the patient says it is. Sorry patients, there are simply too many addicts prowling doctor’s offices with detailed, fraudulent claims of pain fabricated to obtain opioids. Common sense and science tell us to “find the cause of pain before you prescribe.”
It’s hard to believe, but the International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience.” I can’t wait to ask United Healthcare and Medicare to pay for an expensive drug with this definition.
It is important to point out that the term “legitimate pain” is not only lacking in regulatory guidelines, but it is also not found in medical dictionaries. Pain may be an experience, emotion or sensation, but it has historically been regarded as a symptom of an underlying disease or injury.
For example, the Dunglison’s Medical Dictionary of 1874 says “pain is generally symptomatic.” Medical practitioners today, however, need a new definition of pain because the term “legitimate” is now used to justify treatment with opioids and other controlled drugs.
Here is my definition of pain, which I believe will generally satisfy all parties, including patients, practitioners, governmental bodies, insurance companies, and the media:
“A stressful symptom caused by a disease or injury that can be objectively identified by diagnostic tests or physical examination.”
In the past, an argument was made that some causes of pain, such as fibromyalgia and headaches, can’t be objectively verified. This may have been true in the past, but today’s technological advances in medical imaging and laboratory tests, along with a detailed physical examination, can objectively determine the cause of nearly every source of pain.
An examination of my submitted definition not only implies that a medical practitioner has the right to treat the patient, it also implies that the practitioner has an obligation to treat both the pain and the cause.
Forest Tennant, MD, DrPH, is retired from clinical practice but continues his research on the treatment of intractable pain and arachnoiditis. Readers interested in learning more about his research should visit the Tennant Foundation’s website, Arachnoiditis Hope. You can subscribe to its research bulletins here.
The Tennant Foundation gives financial support to Pain News Network and sponsors PNN’s Patient Resources section.
