PROFESSIONJoint Commission increases focus on pain managementNew standards should serve as another tool to help physicians navigate the difficult course of effective treatment of pain.By Vida Foubister, amednews staff. June 26, 2000. Chicago -- The Joint Commission on Accreditation of Healthcare Organizations' new pain standards will require physicians to better document their treatment decisions. But the standards, which go into effect Jan. 1, 2001, are expected to do something for doctors in return. "By getting into more formal assessment and evaluation [of pain], and then the monitoring of it, I believe that the physician is better protected," said Robert A. Wise, MD, vice president of standards at the Joint Commission in Oakbrook Terrace, Ill. This protection is, of course, from Drug Enforcement Administration and state licensing board scrutiny, which has long been blamed for physicians' undertreatment of pain. The Pain Relief Promotion Act, now pending in the U.S. Senate, and model guidelines adopted in late 1998 by the Federation of State Medical Boards aim to lessen doctors' fears about the appropriate prescription of narcotics. However, the threat to their medical licensure continues to loom large in the minds of many physicians. "We have to eliminate barriers," said Perry G. Fine, MD, professor of anesthesiology at the University of Utah, Salt Lake City. Opportunity for changeNearly 400 health care professionals came together to learn what their organizations must do to meet the new standards at a summit sponsored in Chicago last month by Joint Commission Resources, a subsidiary of the Joint Commission, and the American Pain Society. A second summit is scheduled for July 31 in Los Angeles. "The undertreatment of pain is a major public health problem," June L. Dahl, PhD, a professor of pharmacology at the University of Wisconsin Medical School, Madison, told those in attendance. "The development of these standards by the Joint Commission is truly a milestone in efforts to overcome this problem." Much of the discussion, however, focused on the many remaining impediments to effective pain management, chief among them a lack of communication with patients. Because of the subjective nature of pain and the need for individualized treatment, patients need to be involved in developing an appropriate pain management plan. Yet many patients continue to fear addiction or other side effects and thus often fail to voice their need for relief. "We need to teach people that we don't know how they feel unless they tell us," said Karen L. Syrjala, PhD, associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine in Seattle. "We want people to use their energy to fight their disease, not to fight their pain." In an effort to educate patients about their rights and responsibilities, the American Pain Foundation is rolling out a "Stop Pain Now!" campaign this fall. The foundation plans to publicize the Joint Commission pain standards and encourage hospitals and other institutions to adopt a pain patients' bill of rights. "We see this as a real opportunity and perhaps a turning point in getting patients better informed about pain management possibilities and better able to be assertive for themselves to be sure their pain needs are addressed," said Jim Guest, the foundation's executive director. Other barriers include the failure of medical schools to educate physicians about pain management and insurers who do not adequately compensate physicians for the time it takes to relieve suffering, Dr. Fine said. As a result, "pain management is not valued within the established medical culture as a credible or highly respected discipline or specialty." More than one answerMany at the meeting were looking for guidance on how to implement the standards at their institutions, but the Joint Commission intentionally wrote the standards broadly. "We wanted to avoid being prescriptive so that organizations could find creative ways to provide high-quality care rather than telling them 'this is the way you must do everything,' " said Richard S. Frankenstein, MD, a California physician who serves on the Joint Commission board of commissioners. The standards were accepted in August 1999 and included in the standards manual this year. Though they are currently being scored for compliance, they will not count toward a facility's final accreditation decision until 2001. Pain experts unanimously agree that better care is needed, yet some question the focus on the prescription of narcotics. Joel R. Saper, MD, director of the Michigan Head Pain and Neurological Institute in Ann Arbor and chair of the Pain Care Coalition, said he'd like to see more discussion of other treatment options, such as behavioral modification and medicines other than narcotics. "Better pain care in the minds of many is being equated to just giving more narcotics," he said. "That's not the essence of better pain care in this country, that's a piece of better pain care." ADDITIONAL INFORMATION:Focusing on painThe Joint Commission's new standards emphasize that pain, although it coexists with a number of conditions, requires explicit attention. With that in mind, health care facilities must:
Source: Joint Commission on Accreditation of Healthcare Organizations Copyright 2000 American Medical Association. All rights reserved.
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