The History of Medical Consumerism, Pain Management, and Prescription Opioids

John Giardina


Over the last few decades, pain treatment and the practice of pain management in the United States have changed dramatically. There are a number of historical forces that have contributed to these changes, but one particularly powerful one has been the tendency of the American patient and healthcare system toward medical consumerism. Since the late 1960s, this trend of medical consumerism has manifested itself in part through patients’ increasing activism and engagement in care, and through market-oriented health policy reforms, including the rise of managed care and the liberalization of medical advertising. These forces have had a particular influence on pain management practices, both positive and negative. Positive effects include an increased attention to patients’ experiences of pain, while negative effects include a decreased ability of patients and their physicians to implement comprehensive and holistic pain management interventions and an corresponding increased reliance on opioid analgesics. The results of this paper suggest that, in order to adequately address the current opioid crisis, these historical forces need to be recognized and addressed.