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1: Rutgers Law Rev. 2002 Spring; 54(3):649-84.

Raising the "civilized minimum" of pain amelioration for prisoners to avoid cruel and unusual punishment.

McGrath J.

Appalachian School of Law, USA.

This Article addresses the problems with our nation's cultural and legal prohibitions against certain pain management treatments. The practice of pain management has not kept pace with the many medical advances that have made it possible for physicians to ameliorate most pain. The Author notes that some patients are denied access to certain forms of treatments due to the mistaken belief that addiction may ensue. Additionally, some individuals are under-treated for their pain to a greater degree than are others. This is especially the case for our nation's prisoners. The Author contends that prisoners are frequently denied effective pain amelioration. He notes, however, that there has been improvement in medical treatment in general for prisoners due to court challenges based on the Eighth Amendment's prohibition against cruel and unusual punishment. Yet, due to the protection of qualified immunity given to jailers and prison health care providers, prisoners cannot bring a claim for negligence or medical malpractice, they must allege a violation of their constitutional rights, a significantly higher legal standard. Prisoners must meet a subjective test showing that there was a deliberate indifference to their medical needs that violates the protection of the Eighth Amendment. The Author concludes that because medical advances have made it possible to alleviate most pain suffering, withholding pain treatment or providing a less effective treatment is tantamount to inflicting pain and should be viewed as a violation of the Eighth Amendment.

2: Ann Health Law. 2004 Winter; 13(1):81-144, table of contents.

Damned if they do, damned if they don't: the need for a comprehensive public policy to address the inadequate management of pain.

Dilcher AJ.

Amy Dilcher examines the need for a comprehensive pain policy… The article synthesizes a number of perspectives regarding the regulation of pain management and demonstrates that the inadequate treatment of pain stems from a multitude of barriers. After reviewing Congressional action on the topic, Ms. Dilcher concludes with recommendations for a more comprehensive pain policy that would enhance the management of pain.

3: J Leg Med. 2003 Dec; 24(4):495-539.

2003 LeTourneau Award. Freedom from pain. Establishing a constitutional right to pain relief.

Weinman BP.

Paul, Weiss, Rifkind, Wharton & Garrison, New York, New York, USA. bdweinman@aol.com

4: Pediatrics. 2000 Nov; 106(5):1054-64.

The Child-Friendly Healthcare Initiative (CFHI): Healthcare provision in accordance with the UN Convention on the Rights of the Child. Child Advocacy International. Department of Child and Adolescent Health and Development of the World Health Organization (WHO). Royal College of Nursing (UK). Royal College of Paediatrics and Child Health (UK). United Nations Children's Fund (UNICEF).

Southall DP, Burr S, Smith RD, Bull DN, Radford A, Williams A, Nicholson S.

Child Advocacy International and the Department of Paediatrics, Keele University, Keele, United Kingdom cai_uk@compuserve.com

OBJECTIVE: Although modern medical technology and treatment regimens in well-resourced countries have improved the survival of sick or injured children, most of the world's families do not have access to adequate health care. Many hospitals in poorly resourced countries do not have basic water and sanitation, a reliable electricity supply, or even minimal security. The staff, both clinical and nonclinical, are often underpaid and sometimes undervalued by their communities. In many countries there continues to be minimal, if any, pain control, and the indiscriminate use of powerful antibiotics leads to a proliferation of multiresistant pathogens. Even in well-resourced countries, advances in health care have not always been accompanied by commensurate attention to the child's wider well-being and sufficient concerns about their anxieties, fears, and suffering. In accordance with the United Nations Convention on the Rights of the Child,(1) the proposals set out in this article aim to develop a system of care that will focus on the physical, psychological, and emotional well-being of children attending health care facilities, particularly as inpatients. DESIGN OF THE PROGRAM: To develop in consultation with local health care professionals and international organizations, globally applicable standards that will help to ensure that practices in hospitals and health centers everywhere respect children's rights, not only to survival and avoidance of morbidity, but also to their protection from unnecessary suffering and their informed participation in treatment. Child Advocacy International will liase closely with the Department of Child and Adolescent Health and Development of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) in the implementation of the pilot scheme in 6 countries. In hospitals providing maternity and newborn infant care, the program will be closely linked with the Baby Friendly Hospital Initiative of WHO/UNICEF that aims to strengthen support for breastfeeding.United Nations Children's Fund, United Nations Convention on the Rights of the Child, child protection, breastfeeding, pain control, palliative care, child abuse.

5: Hawaii Med J. 1997 Aug; 56(8):199-200.

Pain relief as a basic human right.

Osterlund H.

Pain Management Services, Queen's Medical Center.

6: Cancer Invest. 1994;12(4):438-43.

Freedom from pain: a matter of rights?

Hill TP.

7: Lancet. 1993 Sep 4;342(8871):567-8.

Painless human right.

James A.

Lancet, London, UK.

8: Krankenpfl J. 1990 Oct;28(10):526.

[Human rights and pain]

[Article in German]

von Ihering R.

Publication Types: Biography Classical Article Historical Article

Personal Name as Subject: von Ihering R

9: NY Times (Print). 1996 Jun 19;:A6.

In Mexico, pain relief is a medical and political issue.

DePalma A.

10: J Law Health. 1997-98;12(2):381-405.

A proposal to recognize a legal obligation on physicians to provide adequate medication to alleviate pain.

Eippert T.

11: J Law Med Ethics. 1996 Winter;24(4):338-43.

Pain management and disciplinary action: how medical boards can remove barriers to effective treatment.

Hyman CS.

12: Law Med Health Care. 1990 Spring-Summer;18(1-2):132-9.

The role of physicians in human rights.

Nightingale EO.

13: Health Hum Rights. 1994 Fall;1(1):24-56.

The right to health in international human rights law.

Leary VA.

14: J Law Med Ethics. 1998 Winter; 26(4):350-2, 263.

Commentary: the potential for unintended consequences from public policy shifts in the treatment of pain.

Haddox JD, Aronoff GM.

Southeastern Pain & Rehabilitation Institutes, Atlanta, Georgia, USA.

Authors caution against possible unintended consequences of intractable pain treatment acts, suggesting that health care professionals look to the guidelines prepared by the Federation of State Medical Boards for an approach to this issue.

15: Eur J Health Law. 1996 Jun; 3(2):105-7.

Development of patients' rights and instruments for the promotion of patients' rights.

Leenen H.

16: Eur J Health Law. 1998 Dec;5(4):389-408.

The right to health in national and international jurisprudence.

Hendriks A.

17: N Engl J Med. 1998 Dec 10;339(24):1778-81.

Human rights and health--the Universal Declaration of Human Rights at 50.

Annas GJ.

Boston University School of Public Health, MA 02118, USA.

18: Palliat Med. 2004 Apr;18(3):175-6.

The World Health Organization three-step analgesic ladder comes of age.

Reid C, Davies A.

19: WHO Chron. 1976 Sep;30(9):347-59.

Health aspects of human rights.

[No authors listed]

PMID: 969490 [PubMed - indexed for MEDLINE]

20: J Contemp Health Law Policy. 1994 Spring;10:383-403.

No pain, no gain? The Agency for Health Care Policy & Research's attempt to change inefficient health care practice of withholding medication from patients in pain.

Crowley PC.

21: J Health Polit Policy Law. 2001 Apr;26(2):195-215.

Evidence: its meanings in health care and in law. (Summary of the 10 April 2000 IOM and AHRQ Workshop, "Evidence": its meanings and uses in law, medicine, and health care).

Havighurst CC, Hutt PB, McNeil BJ, Miller W.

Duke University School of Law, USA.

22: Qual Manag Health Care. 1999 Winter;7(2):28-40.

Institutionwide pain management improvement through the use of evidence-based content, strategies, resources, and outcomes.

Miller EH, Belgrade MJ, Cook M, Portu JB, Shepherd M, Sierzant T, Sallmen P, Fraki S.

Abbott Northwestern Hospital, Minneapolis, MN, USA.

The Agency for Health Care Policy and Research pain guidelines and implementation theories were used in this improvement initiative to ensure that evidence-based pain management reached every provider and patient in a large tertiary care hospital. Implementation strategies, products, and outcome measures are described for use in the clinical setting. Critical success factors and implementation barriers are also addressed.

23: Duodecim. 2001;117(23):2437-40.

[Life and health as basic rights]

[Article in Finnish]

Laine J.

24: Rev Med Chil. 2000 Dec;128(12):1374-9.

[Human rights and their relationship with patient's rights]

[Article in Spanish]

Trejo C.


This historical article reviews the most important milestones in the evolution of human and patient's rights. The latter have derived from human rights and have followed a similar historical evolution, but in markedly different times. This has lead to the persistence of monarchic type, paternalistic clinical relationship forms in republican societies. The acceptance of informed consent and patient's rights has been a democratization of clinical relationships. On the other hand the right to body health management is a real cultural revolution. The democratization of clinical relationship is in agreement with our technical, pluralist and secularized times.

25: J Law Med Ethics. 2002 Winter;30(4):522-32.

Health and human rights: old wine in new bottles?

Oppenheimer GM, Bayer R, Colgrove J.

Brooklyn College, City University of New York, USA.

26: Lancet. 1998 Oct;352 Suppl 2:SII7-11.

Medical journals and human rights.

Kandela P.


27: Anesthesiology. 1985 Apr;62(4):493-501.

The secularization of pain.

Caton D.

After Morton's demonstration in the Ether Dome of the Massachusetts General Hospital, anesthesia for surgery was accepted around the world at a speed unusually fast for any medical or scientific innovation. However, the concept of surgical anesthesia had been rejected on four occasions during the preceding 40 years. The rapid acceptance of anesthesia in 1846 appears to have had a political and social basis as well as medical. Two factors are particularly important. First was a change in the perception of disease and pain; both lost religious connotations and became biologic phenomena as part of a process of secularization that affected all aspects of Western society. Second was the growth of a sense of well-being and progress, which imbued patients and physicians alike with confidence in their ability to control natural processes. During the last half century, pain has remained secular, but the confidence in both progress and the ability to control nature may have diminished.

28: J Pain Symptom Manage. 2002 Aug;24(2):97-101.

International Association for the Study of Pain: update on WHO-IASP activities.

Breivik H.

World Health Organization and The International Association for the Study of Pain, Oslo, Norway.

29: Cancer Control. 2000 Mar-Apr;7(2):149-56.

Interventional treatment of cancer pain: the fourth step in the World Health Organization analgesic ladder?

Miguel R.

Anesthesiology Service, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.

BACKGROUND: For most patients with cancer pain, the World Health Organization's three-step analgesic ladder provides adequate management with oral or transdermal options. However, some cancer patients are not well palliated with these approaches. METHODS: The author reviews interventional options that include nerve blocks, spinal administration of local anesthetics, opioids, alpha-2 agonists, spinal cord stimulation, and surgical interventions. RESULTS: Numerous interventional options are readily accessible and most can be performed on an outpatient basis. They can be used as sole agents for the control of cancer pain or as useful adjuncts to supplement analgesia provided by opioids, thus decreasing opioid dose requirements and side effects. CONCLUSIONS: Cancer-related pain can be controlled with several interventions when oral or transdermal opioids are inadequate. A risk:benefit ratio should be considered before implementing invasive analgesic methods.


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