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Politics of Pain Epitomizes U.S. Liberal-Conservative Divide
AUSTIN, May 11, 2016 – Although policy issues may change, the debate on how to treat people with chronic pain has been a decades-long battleground in the ongoing liberal-conservative tug of war in American politics, according to author and medical historian Keith Wailoo, Ph.D., keynote speaker today at the American Pain Society Annual Scientific Conference, www.americanpainsociety.org
Even though the federal government recently released the National Pain Care Strategy, Wailoo said that to advance the pain care policy agenda advocates must navigate thorny medical, social and political obstacles that shape the pain care debate – and have shaped it for decades.
"Pain is a political issue and politicians continue to battle over how to regard people who suffer chronic pain," said Wailoo, professor of history and public affairs, Woodrow Wilson School of Public and International Affairs, Princeton University. "Because pain is subjective and not measurable, it has been very controversial for determining disability and it intersects with deep and divisive issues in American society. Liberals have traditionally maintained that America should be a compassionate society and provide relief and financial benefits for pain sufferers, while conservatives have often focused on the enormous cost and suspicions that we are building an unsustainable welfare state," he explained.
People in pain, said Wailoo, have often been caught in the vortex of these political debates. They also pose a challenge for doctors because one person might complain about pain that someone else would tolerate. In addition, concerns about fraud and drug seeking might allow a range of non-clinical judgments to shape diagnosis and care, such as assuming a black person in pain is a drug-abuse risk.
Wailoo noted that ideological divisions over chronic pain were exacerbated in 1956 when Social Security began offering benefits to people with disabilities, and pain became an increasing source of disability claims. "Physicians unwillingly became the gatekeepers in determining which patients had legitimate pain and could file for disability benefits," said Wailoo. "Soon, Social Security payouts skyrocketed and debate raged as to whether pain is a disability that should be compensated by the federal government."
Upon taking office in 1981, President Ronald Reagan ordered the Department of Health and Human Services to cut Social Security disability rolls, which Wailoo said resulted in pain disability claims being targeted. "When pain patients were cut off from Social Security payments, they sued and, more and more, it was judges who decided who is in pain and entitled to disability relief. Pain in effect migrated from medicine to politics to the courts, and judges are deciding who's in pain," Wailoo stated.
Today the pain policy battle continues as liberals and conservatives wrestle with political questions regarding the safety of potent analgesic medications and funding for proposals recommended in the National Pain Strategy.
Wailoo said misuse and diversion of narcotic pain medications now overshadow all other pain policy issues, but those other hot-button pain controversies have not disappeared entirely. "Ideological divisions are evident in policy proposals about opioids, and they go from one extreme to the other. On the left, there is concern that restricting access to opioids harms legitimate pain patients who need these drugs to function every day, while tightening physician prescribing and stopping drug diversion are favored on the right," said Wailoo. "Ultimately, both sides must reach a political accommodation to effectively deal with drug diversion while not limiting medication use by people with real pain."
Wailoo is the author of "Pain: A Political History."
About the American Pain Society
Based in Chicago, the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering. APS is the professional home for investigators involved in all aspects of pain research including basic, translational, clinical and health services research to obtain the support and inspiration they need to flourish professionally. APS strongly advocates expansion of high quality pain research to help advance science to achieve effective and responsible pain relief. For more information on APS, visit www.americanpainsociety.org.