CONTACT: JENNIFER CRONIN
2130 Medical Laboratories
Iowa City IA 52242
(319) 335-5661; fax (319) 335-9917
Release: April 12, 1999
UI study finds many physicians withhold pain medication
IOWA CITY, Iowa -- Many physicians withhold pain medication
from patients in emergency situations because of informed consent issues or
because the doctors believe the drugs may affect the accuracy of their diagnoses,
a University of Iowa survey found.
However, withholding pain medication may actually be a
barrier to informed consent and accurate diagnoses, said Mark A. Graber, M.D.,
associate professor of surgery and family medicine, and the study's principal
investigator. The survey's results did not surprise Graber, an emergency room
doctor who believes physicians should abandon this unnecessary caution against
administering pain medication.
"Current training teaches that we should not use pain
medication because it can affect a diagnosis and informed consent," Graber
said. "However, current studies suggest that giving pain medication may actually
result in fewer unnecessary surgeries. Although decisions about which and
how much medication to administer should be done on a case-by-case basis,
we should be more generous with pain medication."
The results of Graber's survey appeared in the March issue
of the American Journal of Emergency Medicine.
In July 1996, Graber mailed a questionnaire to all 182
general surgeons practicing in Iowa. He wanted to determine their beliefs
about the use of analgesics for acute abdominal pain and examine how these
beliefs affect prescribing patterns.
Of the 131 respondents, 78 percent considered the ability
to obtain informed consent in their decisions to forgo pain medication. The
survey also showed that 53 percent thought the amount of pain medication necessary
to make patients comfortable would prevent the patients from signing a legally
binding informed consent.
Informed consent is an important ethical and legal issue
for all physicians. Valid informed consent requires patients act independently
without coercion. The individuals must have received appropriate, comprehensible
information. At the time of consent, the patients must be able to communicate
The informed consent definition raises two questions,
Graber said. One, does administering pain medication void patients' informed
consent because of a loss of judgment and competence due to mental clouding?
Two, recognizing that no physician would purposefully cause patients to suffer,
can withholding pain medication (external coercion) or the presence of pain,
which may limit the patients' ability to concentrate on and understand doctors'
explanation, invalidate informed consent?
To answer the first question, one need only look at other
medical experiences, Graber said. There are patients who receive large doses
of narcotics, such as individuals with terminal cancer. These people are considered
competent to make their own health care decisions.
As for the second question, patients in pain want to relieve
that pain, Graber said. Therefore, patients may give hasty consent to surgery
or other interventions knowing that once they have, relief will be forthcoming.
These treatments may not be in the patients' best interests.
"Pain relief may actually enhance a patient's ability
to give informed consent by removing coercive factors," Graber said.
In addition to informed consent, doctors also consider
how administering pain medication might affect the accuracy of their diagnoses.
Sixty-seven percent of survey respondents indicated that drugs hindered their
ability to make accurate diagnoses. Graber disagrees with this majority opinion,
pointing out that studies suggest diagnostic accuracy increases with the use
of pain medication because it increases sensitivity and specificity of the
"Since withholding pain medication may actually be a barrier
to informed consent and diagnostic accuracy, these policies should be reconsidered,"