{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:33:43Z","timestamp":1789990423975,"version":"4.0.1"},"reference-count":0,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2015,6,24]],"date-time":"2015-06-24T00:00:00Z","timestamp":1435104000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007461","name":"Brocher Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007461","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Australia's National Health and Medical Research Council","award":["565501"],"award-info":[{"award-number":["565501"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioethics"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Across the world, pain is under\u2010treated in emergency departments (<jats:styled-content style=\"fixed-case\">EDs<\/jats:styled-content>). We canvass the literature testifying to this problem, the reasons why this problem is so important, and then some of the main hypotheses that have been advanced in explanation of the problem. We then argue for the plausibility of two new hypotheses: pain's under\u2010treatment in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> is due partly to (1) an epistemic preference for signs over symptoms on the part of some practitioners, and (2) some <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> practices that themselves worsen pain by increasing patients' anxiety and fear. Our argument includes the following logic. Some <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> practitioners depart from formal guidance in basing their acute pain assessments on observable features rather than on patient reports of pain. This is potentially due to an epistemic preference for signs over symptoms which aims to circumvent intentional and\/or unintentional misrepresentation on the part of patients. However, conducting pain assessments in line with this epistemic preference contributes to the under\u2010treatment of pain in at least three respects, which we detail. Moreover, it may do little to help the practitioner circumvent any intentional misrepresentation on the part of the patient, as we explain. Second, we examine at least four <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> practices that may be contributing to the under\u2010treatment of pain by increasing patient anxiety and fear, which can worsen pain. These practices include failing to provide orienting information and partially objectifying patients so as to problem\u2010solve along lines pre\u2010established by modern medical science. We conclude by touching on some potential solutions for <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> practice.<\/jats:p>","DOI":"10.1111\/bioe.12170","type":"journal-article","created":{"date-parts":[[2015,6,24]],"date-time":"2015-06-24T09:46:51Z","timestamp":1435139211000},"page":"195-202","source":"Crossref","is-referenced-by-count":31,"title":["Why is Pain Still Under\u2010Treated in the Emergency Department? Two New Hypotheses"],"prefix":"10.1111","volume":"30","author":[{"given":"Drew","family":"Carter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Sendziuk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaklin A.","family":"Eliott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Braunack\u2010Mayer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,6,24]]},"container-title":["Bioethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fbioe.12170","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bioe.12170","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T10:22:26Z","timestamp":1695982946000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/bioe.12170"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,6,24]]},"references-count":0,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2016,3]]}},"alternative-id":["10.1111\/bioe.12170"],"URL":"https:\/\/doi.org\/10.1111\/bioe.12170","archive":["Portico"],"relation":{},"ISSN":["0269-9702","1467-8519"],"issn-type":[{"value":"0269-9702","type":"print"},{"value":"1467-8519","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,6,24]]}}}