Editorial: Forensic Pain Medicine

• Forensic: Belonging to, used in, or suitable to courts of judicature or to public discussion and debate (Merriam-Webster Collegiate Dictionary)

• Forensic: Relating to or dealing with the application of scientific knowledge to legal problems (Merriam-Webster Collegiate Dictionary)

• Forensic Science: The application of science to the just resolution of legal issues (American Academy of Forensic Sciences, 1989)

• Forensic Medicine: Application of medicine to the just resolution of legal issues (American Academy of Forensic Sciences, 1989)

Statement

Pain medicine has developed into a multidisciplinary field with burgeoning social importance. Recent laws around pain and suffering, novel challenges in the courts that affect patients and law enforcement, and new moral and ethical debates place Pain Medicine well beyond the usual boundaries of medical science. Currently, national and state legislatures are struggling to produce laws that encourage pain control and simultaneously oppose addiction or physician-assisted suicide. Courts are asked to determine the impact of pain on disability as well as the consequences of clinicians who either over- or undertreat pain. Likewise, correctional institutions struggle with inmates who are the only members of society with a legal right to health care who claim intractable pain and a legal right to chronic opioid therapies.

Although other socially charged areas of medicine have addressed their place in forensic sciences, pain medicine has not yet developed a focused subspecialty discipline to meet these challenges. Patients in pain may be substantially affected by the outcome of actions taken by national or state legislatures, courts, or correctional institutions. Without the expert consultation of our field, these agencies are ill prepared to comprehend the full complexity of pain and the impact of their actions on suffering. Our patients and our field are best served by the field of Pain Medicine refining skills for interfacing with the courts, legislature, and corrections.

While the television show Quincy has set a popular perspective on the meaning of forensics, the larger part of forensic sciences relates to living victims. Forensic medicine deals with legal issues related to medicine ranging from rape, drug addiction, violent crimes, suicide, workplace injuries, drug and food tampering, medical malpractice, and incest, to custody and maternity/paternity claims. Forensics has been most notably subdivided into mental illness (forensic psychiatry), or the use of evidence related to cause, manner and mechanism of death (forensic pathology). Other well-established forensic branches within health care include forensic dentistry, forensic anthropology, forensic chemistry and toxicology, forensic DNA analysis, and forensic social work. The field of pain medicine shares substantial resemblance to other established branches of medical forensics. In particular, it overlaps with forensic psychiatry in its core of subjective symptoms, comorbid disorders, and preponderance of legal and social issues. Thus, forensic pain medicine is the presently undeveloped branch of pain medicine that deals with issues of human pain and suffering in the law and public policy. It is the branch of the subspecialty of pain medicine that is prepared to interface with the courts, legislature, corrections, and other public policy institutions.

This section of Pain Medicine is titled Forensic Pain Medicine and will focus on this new discipline. This new section will hopefully serve as a conduit for advancing ideas and discussion in this specific discipline and help develop this unmistakable subspecialty within our field.