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date: 03 December 2022



  • Terry AltilioTerry AltilioCoordinator of Social Work, Department of Pain Medicine and Palliative Care, Beth Israel Medical Center
  •  and Maris Pasquale DoranMaris Pasquale DoranMaris Pasquale Doran is a licensed clinical social worker with extensive direct patient care experience, addressing the specialized needs of patients in chronic pain. She has written and presented material on the psychosocial impact of chronic pain to professional audiences and as a facilitator of multiple community programs.


Pain is a multidimensional, subjective experience that embodies the complex relationship of body, mind, emotions, and spirit. Assessment begins with the patient’s report and is enhanced by diagnostic tools, skilled inquiry and observation of behavioral, physical, cognitive and emotional responses. Pain may be acute, chronic, intermittent, or persistent and can be related to a chronic condition or progressive life-threatening illness—all of which may lead to significant psychological, spiritual, functional, and socioeconomic consequences. The undertreatment of pain is well documented and ubiquitous, especially in vulnerable populations, including the elderly, infants and children, and ethnic minorities. Inadequate management of pain has been the focus of national and international research and policy and relates to many variables, including the controversy and concerns about the use of opioids which are classified as controlled substances. This classification creates a unique environment of legislative, regulatory, and law enforcement scrutiny most recently exacerbated by the public health focus on the abuse of prescription medications. Pain is a clinical, ethical, policy, and advocacy issue. Advocating for state of the art pain management is a shared responsibility of professionals whose ethical codes include social justice, beneficence, and commitment to vulnerable populations.


  • Clinical and Direct Practice
  • Health Care and Illness

Updated in this version

Substantial material added to address the current social, political, economic, and ethical perspectives related to pain management and prescription drug abuse, including impact on prescribers and patients. Bibliography expanded and updated.

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