Ethical insights to rapprochement in pain care: bringing stakeholders together in the best interest(s) of the patient.

Advances in medicine have produced an elongated lifespan often burdened by chronic disorders. Throughout the lifespan and at end of life such disorders can give rise to intractable pain. Although clear distinctions about the respective role(s) for pain therapeutics and palliative medicine remain debatable, both are involved in chronic pain care. Such care has reached a point of crisis fueled by tensions within and between clinical, administrative, and economic factors. We call for a strategy of rapprochement to reconcile these tensions as a means to facilitate more effective and ethically sound pain care. We describe roles and values of principal stakeholders: palliative- and pain-care physicians, chronic pain patients, insurance providers, and hospital administrators and elucidate how dissonances between these groups may contribute to inefficacy of the pain care system and sustain chronic, maldynic pain. We discuss how such values affect use of evidence and resources and explicate frameworks for an ameliorative rapprochement model that acknowledges and balances relative needs and values of all stakeholders. While we have tried to depict why rapprochement is necessary, and possible, the more difficult task is to determine how this process should be articulated and what shape a profession of total pain care might assume.