Annals of Health Law
INTERVENING AT THE RIGHT POINT
social gradients, pain is therefore an enormous health problem. There is no
serious suggestion from virtually any stakeholder denying this conclusion.
Quite the contrary, cross-sectoral stakeholders at all geopolitical levels have
devoted significant attention and resources to ameliorating the problem,
from basic research (e.g., the National Institutes of Health Pain
Consortium)27 to calls for better access to medicines needed for the
treatment of pain (e.g., the WHO Access to Controlled Medicines
Programme).28 The overwhelmingly dominant L&P approach to
diminishing the burden of pain across the globe has tracked the latter,
aiming to facilitate access to opioid analgesics and/or other pharmaceuticals
used to treat pain. This is true both in the global North, as embodied in the
paradigm of “balanced pain policy” championed by the University of
Wisconsin’s Pain & Policy Studies Group (“PPSG”),29 and in the global
South, as demonstrated by the WHO’s so-called “opioid ladder” and their
aforementioned access program.30 Legal scholars addressing the issue have
tracked the dominant L&P paradigm by focusing virtually all of their
attention on the opioid regulatory regime, both domestically and as it
regards global pain.31
27. See NIH PAIN CONSORTIUM, http://painconsortium.nih.gov/(last visited January 4,
28.Se e WHO ACCESS TO CONTROLLED MEDICINES PROGRAMME, http://www.who.
int/medicines/areas/quality_safety/access_to_cmp/en/ index.html (last visited January 4,
29. UNIVERSITY OF WISCONSIN, PAIN & POLICY STUDIES GROUP, http://www.
painpolicy.wisc.edu/ (last visited January 4, 2013). The approach centering on balance is
typically contained in its “Policy Evaluations,” the latest editions of which are set for release
in March 2013.
30. See WHO PAIN RELIEF LADDER, http://www.who.int/cancer/palliative/painladder/
en/ (last visited January 4, 2013); Paul Glare, Choice of Opioids and the WHO Ladder,
33(Supp.) J. PED. HEM./ONC. S6 (2011); WHO ACCESS TO CONTROLLED MEDICATIONS,
supra note 22.
31. E.g., Vence L. Bonham, Race, Ethnicity, and Pain Treatment: Striving to
Understand the Causes and Solutions to the Disparities in Pain Treatment, 29 J. L. MED. &
ETHICS 52, 59-60 (2001) (conceptualizing racial pain inequalities in terms of clinical medical
treatments of pain); Amy J. Dilcher, Damned If They Do, Damned If They Don’t: The Need
for a Comprehensive Public Policy to Address the Inadequate Management of Pain, 13
ANNALS HEALTH L. 81, 83-90 (2004); Michael Finch, Law and the Problem of Pain, 74 U.
CIN. L. REV. 285, 298-303 (2005); J. David Haddox & Gerald M. Aronoff, Commentary, The
Potential Unintended Consequences from Public Policy Shift in the Treatment of Pain, 26 J.
L. MED. & ETHICS 350 (1998); Macon Jones, Note, Protecting Dr. Smith While Treating the
Chronic Pain of Mrs. Jones: Why the Indiana Medical Licensing Board Should Pass
Guidelines for Using Controlled Substances for Pain Treatment, 9 IND. HEALTH L. REV. 695,
701-09 (2011); Timothy McIntire, Is the Pain Getting Any Better? How Elder Abuse
Litigation Led to a Regulatory Revolution in the Duty to Provide Palliative Care, 11 ELDER
L.J. 329, 338-46 (2003); Bhavani S. Reddy, The Epidemic of Unrelieved Chronic Pain, 27 J.
LEGAL MED. 427, 433-41 (2006); Ben A. Rich, The Politics of Pain: Rhetoric or Reform, 8
DEPAUL J. HEALTH CARE L. 519, 527-35 (2001); Taylor, supra note 16 at 557-60.