In the aftermath of the opioid epidemic, the medical community has worked diligently to correct the mistakes of overprescribing. Prescription monitoring programs, education reforms, and more conservative guidelines are necessary and appropriate. But in the process of swinging away from one crisis, we may have inadvertently created another: a health care culture where patients in legitimate pain are now too often dismissed, doubted, or inadequately treated.
I write this not just as an NP, but as a patient.
Several months ago, I suffered a traumatic fall and sustained a comminuted humeral head fracture — a painful and functionally devastating injury. As a clinician, I understood the severity of the fracture and what recovery would entail. Yet I was wholly unprepared for how poorly the system would manage my pain.
Despite clear radiographic evidence of a serious injury, my initial treatment plan included minimal pain relief. At times, I was met with skepticism or treated as though I were exaggerating. I wasn’t seeking long-term opioids — I was seeking basic, compassionate, short-term relief to get through the acute phase of a disabling injury. Still, I felt reduced to a liability rather than recognized as a suffering patient.
I couldn’t help but wonder: If this is how I’m treated — as a medically literate professional with a clear diagnosis — how are others faring? Patients with complex conditions? Patients without credentials or language fluency? Patients who were marginalized or stigmatized?
When Clinical Fear Overrides Compassion
This shift in pain management did not happen in a vacuum. The overprescribing of opioids undeniably contributed to addiction and death. However, the current climate is defined more by fear than by balance. Many clinicians are afraid — afraid of scrutiny, of license loss, of criminal charges. In some settings, prescribing opioids at all, even when clearly indicated, can feel like inviting trouble.
Pain management has become so stigmatized that it’s often avoided altogether. Some clinicians no longer prescribe opioids under any circumstance. Others default to one-size-fits-all strategies, limiting pain medications based on policy rather than patient presentation. Unfortunately, blanket policies don’t reflect the diversity of clinical needs. They lead to a chilling effect, where physicians prioritize risk mitigation over appropriate, individualized care.
This is especially harmful to patients with autoimmune diseases, severe fractures, cancer, or postoperative complications — people whose pain is real, persistent, and often multifactorial. In these cases, conservative treatments may not be enough. We need options and the clinical freedom to use them.
Pain Is Not a Moral Failing
We must also challenge the underlying stigma that still surrounds pain itself. There is an unspoken bias that views pain as a weakness or, worse, as suspicious. This bias disproportionately affects women, people of color, and those with chronic conditions. When patients are forced to “prove” their pain, it damages the therapeutic alliance and creates moral injury for clinicians who feel powerless to help.
Pain is a clinical problem, not a character flaw. The decision to treat it should be rooted in trust, evidence, and compassion, not punitive oversight.
A Call To Rebalance
I am not advocating for a return to the overprescribing culture that created a public health crisis. But I am urging our profession to recognize the consequences of overcorrection.
We must restore balance.
This means:
- Re-centering clinical judgment and individualized care in pain treatment decisions
- Empowering physicians with clear but flexible guidelines that account for complexity
- Supporting multimodal approaches to pain that combine medications, physical therapy, psychosocial support, and interventional techniques
- Addressing clinician fear through education, institutional backing, and clarity from regulators
- Listening to and validating patient experiences, especially when objective findings support their reports of pain
Pain may be subjective, but it is not invisible. When undertreated, it has real, measurable impacts: functional decline, sleep disruption, mental health deterioration, and prolonged disability.
As clinicians, our first charge is to do no harm. But withholding appropriate pain relief, especially in the context of acute trauma or complex disease, is its own form of harm. I experienced this harm firsthand, and I now carry that experience into every patient encounter.
We have the tools and knowledge to treat pain responsibly. We must also have the courage to do so compassionately.
How do we find the balance between responsible prescribing and compassionate pain care? Share in the comments.
Mechelle Caswell-Herrera, NP, is a double board-certified NP with over 30 years of experience in medicine. Her clinical background spans primary care, urgent care, and chronic disease management, with a strong emphasis on ethical, evidence-based practice. A longtime advocate for compassionate pain management, she brings both professional insight and personal experience following a traumatic orthopaedic injury. Her work focuses on bridging the gap between patient needs and evolving clinical guidelines.
Illustration by Jennifer Bogartz
