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LETTER TO THE EDITOR

Fitness of Patients in Pain to Make Optimal Decisions

Department of Anesthesiology and Pain Medicine; University of Alberta, Edmonton; Alberta, Canada; bruce.dick{at}ualberta.ca

In Response:

We appreciate the comments by Dr. Tabboush1 that pain has the potential to result in significant and pervasive effects on individuals. The research that Dr. Rashiq and I have carried out2 that was cited by Dr. Tabboush did find that chronic pain impacts cognitive function. Previous research has also supported that finding. There is little question that pain, particularly severe intractable pain, has the potential to impact an individual's ability to make informed choices. At the same time, we urge that great caution be used when considering the extent to which pain might invalidate an individual's ability to make choices.

Cognitive disruption related to pain can have considerable effects on mental health, quality of life, and pain-related disability. However, the cognitive deficits noted in our research were, in our opinion, not severe enough that we would consider calling into question our participants' ability to make important life choices. The existing research on the effects of pain on cognition point toward a general trend in which cognition is most impaired when pain levels and the demands of the task being performed are high. Furthermore, there are a number of other factors that are known to influence pain's effects on cognition. We concur with Dr. Tabboush that this issue is complex and will require the cooperation of legal and clinical experts to adequately address it. Much remains to be learned regarding this issue that has important ethical, legal, and health policy implications.

REFERENCES

1. Tabboush ZS. Fitness of patients in pain to make optimal decisions. Anesth Analg 2008;106:669[Free Full Text]
2. Dick BD, Rashiq S. Disruption of attention and working traces in individuals with chronic pain. Anesth Analg 2007;104:1223–9[Abstract/Free Full Text]

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