Talk:Undertreatment of pain

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 2 June 2020 and 10 July 2020. Further details are available on the course page. Student editor(s): Ruthieod, Josiemills99. Peer reviewers: Seniork99, Kcl55.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 04:32, 18 January 2022 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 26 January 2021 and 5 May 2021. Further details are available on the course page. Student editor(s): TeakHo, Cnoellec49, Amyzhou314. Peer reviewers: Rani110, Sh1539, Kmg121, Laurencox1, Rowanmoreland.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 04:32, 18 January 2022 (UTC)

About this article

I started this article by copying the section on "undertreatment" in the pain management article to here. After collecting that as a base, I applied the medical manual of style guidance for formatting diseases, as if "undertreatment of pain" were its own disease. This was a bit of an odd choice, because "undertreatment of pain" is not usually recognized as its own medical condition. Still, I imagined that it is a health state that can be classified, has signs or symptoms, has an epidemiology, and its own history, social background, and direction for research.

I made this article because the concept is being raised in other articles, and I thought it would be useful to centralize discussion here in an article just for this topic. Blue Rasberry (talk) 17:35, 28 July 2016 (UTC)

I am thinking that using a disease format and the medical style manual was a good first step, but it looks like the article could have a better flow if several things were changed. I'd like to combine the "Causes" and "Society and Culture" sections, since there are many social factors that lead to undertreatment, and also combine "Epidemiology" and "Special Populations" into a new section, "Affected Populations," right above "Causes." I'm going to try restructuring these now, please let me know if there are any concerns. MBJAnderson (talk) 19:01, 17 October 2020 (UTC)

Article organization and future directions

I have some proposed changes to the structure of the article. First, since the sections under the 'social, political, and cultural factors' are now focusing on different regions around the world, maybe a better header would be 'epidemiology' and I think that could be its own individual section. I'm thinking for the 'causes' section, it could be more broad and just describe the role of opiophobia, physician ideals and practices, access, education, etc, and be split into a cultural, political subsection and a medical subsection; an alternative could be at the patient level, physician level, and healthcare system level. Second, I wonder if the 'classification' section is really necessary. I don't know if it makes the most sense to include it; perhaps the small paragraph that's there right now can move to the very beginning and be part of the Lead? I went ahead and made some changes already, but the expansion of the 'causes' section and updating of the Lead could be a future project for other groups to add to. Just some of my ideas for now! --Amyzhou314 (talk) 00:46, 27 April 2021 (UTC)

Directions for development

I did some searches to see what has been published on this topic. I saw the following -

Italy kept many opioids illegal until 2001

• Opioids in Italy
• Bandieri, E.; Chiarolanza, A.; Luppi, M.; Magrini, N.; Marata, A. M.; Ripamonti, C. (12 March 2009). "Prescription of opioids in Italy: everything, but the morphine". Annals of Oncology. 20 (5): 961–962. doi:10.1093/annonc/mdp041.

I do not follow the story here, or how this works since I expected most European law would have been the same, but a lot of papers cover access to pain relief in Italy. Perhaps some of these paper discuss variation in access to pain relief.

Cancer pain

Cancer pain is its own article. Cain pain itself is a topic which has received attention in print, then lack of treatment for cancer pain also has papers covering the idea.

Activism

I started a history section that mentions some organizations. There seem to be several organizations which campaign in this space, and also individual people. There could be some collection of people and organizations which issue statements on undertreatment of pain. Human Rights Watch has a narrative of the history of this topic but other organizations may have their own versions.

Special Populations

Our project is looking to add information into the special populations section about the differences in pain treatment between racial groups and genders. Our plan right now is to add roughly one paragraph for each population, mirroring the discussion about elderly patients. We also may add a sentence or two under society & culture to reflect our additions to special populations. Additionally we will modify the lead of the article to reflect those same changes. --Josiemills99 (talk) 17:47, 18 June 2020 (UTC)

Blue Rasberry (talk) 14:24, 29 July 2016 (UTC)

Under-treatment: this whole section, including the title could be less biased (see talk)

(content moved here from Talk:Pain management. Blue Rasberry (talk) 14:27, 29 July 2016 (UTC))

"under-treatment", "neglect", and "deficiencies" is not the language used in the cited articles. I didn't read them all but I open up a sample because the language used in this section set of my alarm bells. The cited articles I read talked about "variability" in length of treatment and "differences" in chosen treatments. That is the kind of thing I expected to find and far more reasonable language for this section. Since the cited articles do not focus on fear, neglect, and deficiencies as their main point, so we shouldn't either. The articles I read simply stated the facts of variability in treatment and that a more consistent pain management methodology is suggested.

Also, the tone of this section is as if there is something wrong with a culture whose social and religious tendencies shy away from pain management. Yet again, this primary focus of the cited articles is not to chastise archaic cultural beliefs. This judgement appears to have been introduced by the writers of the section. A neutral tone would be more appropriate for this section.

I have retitled the section "treatment variability"

I think I would introduce counter bias if I was to rewrite the section. I would love for a neutral contributor to give it a go.

49.176.3.204 (talk) 08:07, 27 September 2012 (UTC)

A counter point of view would be welcome in this section, as perhaps also better sources or references, but under treatment of pain is too big a topic to be ignored, with hundreds or thousands of books and article published on the subject! "Treatment variability" is quite another topic. --Robert Daoust (talk) 13:44, 27 September 2012 (UTC)

There's a plethora of books and articles on overtreatment also. Just have a look. I suspect your personal focus is on undertreatment so you are overlooking the former. 58.175.249.163 (talk) 07:06, 28 September 2012 (UTC)

Very good point! Overtreatment should be added as another section, dealing with drug prescription problems, useless back surgery, overtreatment of chest pain, etc. --Robert Daoust (talk) 14:43, 28 September 2012 (UTC)

"Overtreatment"? I've never heard of that. Do you mean "over-prescribing"? --Anthonyhcole (talk) 17:48, 28 September 2012 (UTC)

I hope I've addressed your neutrality concerns with this edit. I'm fairly sure all the sources for that section conform to the guideline Wikipedia:Identifying reliable sources (medicine). If you think there are still problems with the section, please elaborate. --Anthonyhcole (talk) 18:45, 8 October 2012 (UTC)

Yes, that's a great help. I don't think it completes us addressing the neutrality issue. I'm open to a section on overprescribing/overtreatment etc or including a balance in the current section. My preference is still for a section on "variability of treatment" as that is the language used in the most prominent articles cited, as far as I saw. So a section on variability of treatment followed by two subsections. Under and Over, etc. Thanks for the discussion. 49.176.36.166 (talk) 05:46, 26 October 2012 (UTC)

As someone who has experience in pre-hospital trauma and hospital settings, I must say that "undertreatment" is 50/50 these days. Most hospitals will, at least in principal, yearn to treat pain liberally. Where there is marked reticence to prescribe appropriately would be in a general practice setting, such as doctors or dentists. Based on knowledge that qualifies as WP:OR (yet easily justified with Google search), this is due to the fear of drug-seeking behavior, prescription diversion, and/or unwanted attention from the DEA or state for prescribing them. If not for these reasons, there is the simple ignorance of many healthcare workers, especially older ones, regarding current best practices for and research on pain management.

Effective and compassionate control of pain continues to be an issue, at least in the US; the problem here is synthesizing this fact in a way that conforms to WP verifiability. The section is, as a whole, not terribly NPOV, but could be edited for clarity, and I wouldn't be opposed to changing the title to "Variability in treatment". — VoxLuna ☾ ^orbit_land   21:37, 24 December 2012 (UTC)

The little I know about this comes from textbooks and journals addressing pain management, and there the problem is almost universally described as undertreatment. The only commentary on overprescribing that I've encountered in those sources is in relation to what you mention: fear of being accused of it (combined with simple ignorance of best practice) leading many doctors to undertreat. There must be serious science on the issue of overprescription. What proportion of prescriptions for opiates are estimated to be overprescribing, and how does that compare with the percentage of prescriptions that should be written but aren't? A sense of the scale of the two problems would be good. (Recent evidence in cancer pain suggests nearly 50% is undertreated in that field.) --Anthonyhcole (talk) 01:20, 25 December 2012 (UTC)

==Wiki Education assignment: Medicine, Race, and Gender== This article was the subject of a Wiki Education Foundation-supported course assignment, between 12 January 2022 and 3 May 2022. Further details are available on the course page. Student editor(s): Teaghanf12, Ad1549 (article contribs). Peer reviewers: NesreenShah, VelenWu, Wp.tamiya.georgetown2022.

Editing and Expanding Gender Section:

I am proposing that we expand the gender section of this article. Research and data from peer reviewed sources show the discrepancies that exist in the belief and treatment of pain according to gender, specifically affecting women. We will specifically be discussing the systematical shortfalls in medical authorities believing women's pain as related to menstruation and chronic conditions related to it, such as PCOS and inflammatory bowel disease. We will also mention the intersectional nature of this issue, and how race can to make women and LGBTQ individuals further vulnerable to the medical neglect of their pain. As such we will be examining how lack of belief and misdiagnosis have contributed to the mistreatment of women.Teaghanf12 (talk) 21:33, 16 March 2022 (UTC)teaghanf12