Beyond opioid regulation: Why a social and cultural analysis of pain in America is a prerequisite for ethical evidence-based pain policy

This dissertation constitutes an attempt to understand the social, cultural, legal, and political reasons for the widespread undertreatment of pain in the United States, and to prescribe evidence-based policy recommendations for improving culture and practice as to the treatment of pain. Though the American problems in treating pain have, over the last three decades, produced an abundance of scholarship, practical guides, and policy analyses, relatively little progress has been made. To the contrary, there is evidence that problems in treating pain have worsened, particularly as to disparities in treating pain effectively. It is curious that virtually any handbook of pain management stresses the need for a multimodal approach, but that there exists a paucity of interdisciplinary analyses of pain. Using the lenses of the medical humanities, I complete an interdisciplinary analysis of pain in the United States. Centering on ethics, policy, and the history of medicine, this analysis forms the theoretical framework upon which I erect a series of evidence-based policy recommendations addressing the treatment of pain. The dissertation in itself makes clear to the reader the characteristics of a medical humanities approach to health, illness, and healing.