Pain relief

Pain relief

New hospital guidelines give patients the right to pain management

Dec. 28, 2000

The Joint Commission on Accreditation of Healthcare Organizations has issued new guidelines on pain management, and hospitals must soon comply or risk losing their accreditation.

The new guidelines require that every patient’s level of discomfort should be assessed regularly and frequently, and effective pain relief must be provided, monitored and adjusted when appropriate.

Many healthcare consumers undoubtedly will be surprised to learn that such a requirement does not already exist, and that pain control has not been a top priority in medical care. After all, patients often seek such care because of pain, which is a useful indicator of dysfunction in organ systems. Once the cause is identified, they expect their symptoms to abate.

One problem is that patients sometimes are not able to communicate the details of their discomfort. They may feel "complaining" is not appropriate, or they may believe that a provider would have offered pain medication if he or she thought such treatment would be effective. Physicians and nurses, conversely, may be under the impression that patients are not suffering from pain because they have not mentioned any.

Under the new guidelines, patients will be asked to rate their discomfort on a scale between 0 and 10, and providers will be required to respond appropriately. That may mean increased use of narcotic pain medications, which occasionally are shunned because of the potential they present for dependency.

Experts in the field of pain management say that risk is exaggerated and that, in fact, patients whose pain is managed appropriately are less likely to become addicted to pain medications because they will not develop an intense fear of pain. In addition, more open dialogue between patient and provider about pain is likely to improve the efficacy of the healthcare delivery system in general, possibly reducing the level of pain experienced.

Another concern is deceit by patients whose main goal is to acquire narcotics. The existence of clear guidelines for the management of pain helps prevent that.

JCAHO has considerable clout in enforcing these guidelines, because Joint Commission accreditation is an important credential for healthcare organizations that wish to bill government programs such as Medicare for medical services in a climate of shrinking reimbursement. To have such an organization proclaim that every patient has a right to effective pain relief is a major step forward in the field of patient rights. Such a right is also an effective tool in making patients partners in their own care, and that can only benefit all of the partners: physicians and hospitals as well as patients themselves.