Pain questions not leading to better control

A study finds that pain measures alone do not necessarily improve care.

By Victoria Stagg Elliott, AMNews staff. June 26, 2006.

Although more emphasis has been placed on charting patients' pain as a vital sign, recognition is growing that efforts are still needed to ensure action to relieve pain once it is measured.

"We should have known that [recording pain scores] would only be a starting point," said James N. Campbell, MD, a professor of neurosurgery at Johns Hopkins University School of Medicine in Baltimore and a strong supporter in the push to make pain a fifth vital sign.

Over the past decade, the Veterans Health Administration and the Joint Commission on Accreditation of Healthcare Organizations, among others, have instituted standards requiring that every patient be assessed for pain at every clinical encounter.

Several studies have found that the JCAHO standards have led to more satisfaction with pain management among hospitalized patients, but increases in full assessments of pain or more frequent treatment did not follow. In the outpatient setting, the impact has been similar. According to a paper in the June issue of the Journal of General Internal Medicine, the VHA's initiative also may not have translated to improved pain care.

Researchers from the Veterans Affairs Greater Los Angeles Healthcare System and Oregon's Portland VA Medical Center reviewed records of 600 patients before and after the initiative and found that, even though most patients were asked about pain levels, in many cases the patients' difficulties were not assessed further, nor were they prescribed medication to alleviate their discomfort. Even patients with significant pain still were likely to have it managed inadequately.