Physiotherapy for patients with chronic pain : ethical aspects

Abstract

20% of adults worldwide have chronic pain; and another 10% of adults are newly diagnosed yearly with chronic pain. The intensity of such distress and associated impairment are significant factors in the assessment of its burden since chronic pain affects the quality of life profoundly. A large and widening gap exists between sophisticated pain knowledge and competent utilisation of this knowledge in practice. On September 3, 2010, the Declaration of Montreal was adopted by delegate countries of the International Pain Summit affiliated to the International Association of the Study of Pain. The Declaration of Montreal was adopted to draw attention to insufficient knowledge of pain management by health professionals and the absence of national policies addressing pain as a global health problem. It is now recognised that what disables patients are usually not their actual conditions but those barriers they face, such as financial dependency, stigma, etc. Due to the biomedical culture devaluing psychosocial contexts of pain, particular difficulties arise in addressing the pain experience. The chronic pain patient, at some point during his/her illness, is forced to face transcendent dilemmas, where his role/meaning in the world, has to be redefined. When suffering is observed as a singular phenomenon for every patient, with a strict focus on the body or the mind, it neglects the soul and ignores the most central part of being human. Understanding the patient in pain, therefore, has implications for adoption of the biopsychosocial-existential approach. Reviving dormant capacities and enabling those skills needed for meaningful action, the Capability Approach is a form of thinking about how individuals are coping, and how their quality of living can be assessed. Persistent pain necessitates phenomenological inquiry, where the possible roots of symptoms may be derived from the patients’ subjective responses, through their narratives. Narratives can serve to enact justice to patients and respect their autonomy since they give them a sense of relevance by recognising them as partners in their care. In morally challenging circumstances, such as chronic pain, there is conflict between ethical principles and specific judgement results, and no ethical principle is a priori privileged. By utilising ethical principles and virtues, the physiotherapists will be able to resolve ethical dilemmas specific to the unique pain experience of their patients in a robust physiotherapeutic relationship.