On the Changing Pain heading, we’ll publish articles that thoughtfully take a stance that is different than the generally accepted views on the particular topic of the article. These articles may offer a 
new perspective or challenge conventional wisdom.
As such, you may not always agree with the articles published under the heading of Changing Pain. Indeed, even those of us who publish at the Institute for Chronic Pain might not all agree on a particular author’s viewpoint.
But that’s really the point of the Changing Pain banner. The articles published here will be well-argued stances on topics that are not fully settled among stakeholders in the field of pain management. These articles, in other words, will take stances that reasonable people might disagree.
Our hope is to create a space in which stakeholders can come together to initiate dialogue. In this dialogue, we recognize that not everyone will agree, but we aspire to thoughtfully consider the points of view of others. Often, in pain management, like politics these days, stakeholders have very strongly held views in which dialogue ensues, not as reasoned discourse, but personal attacks against the character of those who hold the contrary view. Issues related to opioids, disability, the role of coping, stigma, and even the nature of pain itself can often be such points of contention among different stakeholders.
Changing Pain attempts to be a place to publish articles from different points of view in the hope that all of us thoughtfully reflect on views that may or may not adhere to our own. Our hope is that these articles serve to bring us together in our differences, rather than being an arena for attacking each other.
To this end, as stated, we publish the first of these articles, entitled Opioid Dependency and the Intolerability of Pain. This article explores the different, and often contradictory viewpoints, of whether and how severe pain is intolerable and thus requires opioid therapy. In it, we see the reasoning that leads to two contradictory treatment recommendations: how some in the field conceptualize the intolerability of pain in such a way that the long-term use of opioids is the only ethical and humane practice; while still others conceptualize the intolerability of pain in patients using long-term opioids as the result of the therapy itself and so opioid tapering is the only ethical and humane practice.
Anyone remotely familiar with issues of pain management will readily recognize that we live and work in a highly unusual time: stakeholders in the field can hold diametrically opposing views, both espousing to be the most ethical and humane practice – some espousing long-term opioid management for patients with severe persistent pain while others espousing that we taper those very same people from opioid management.
It’s a unique time in the history of our field and society.
So, upon reading Opioid Dependency and the Intolerability of Pain, we hope you reflect and respectfully discuss these views and arguments with all the stakeholder with whom you live and work – even those with whom you might diagree.
Date of publication: April 22, 2018
Date of last modification: April 22, 2018
About the author: Dr. Murray J. McAllister is the editor at the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Our mission is to lead the field in making pain management more empirically supported and to make that empirically-supported pain management more publicly acessible. To achieve these ends, the ICP provides scientifically accurate information on pain that is approachable to patients and their families.
