Pain Less of a Sore Spot

National standards are changing the treatment of physical suffering.

By Nancy Luna
Originally published in The Orange County Register, February 24, 2002

Shortly after Scott Tingle turned 25, the pain began. An intense stabbing in his abdomen made him sick all day and prevented him from keeping a steady job.

After dozens of doctor visits, countless tests and a three-week hospital stay, Tingle said, a team of physicians couldn't diagnose him—and all of them ignored his pain.

"No one ever asked if I was in pain unless I brought it up myself," said Tingle, of Orange. After three years, Tingle was diagnosed with Crohn's disease, a gastro intestinal disorder.

Hospitals and other health-care organizations are now being held accountable for protecting patients like Tingle from suffering.

The agency that certifies 18,000 health-care organizations across the country has established new standards to ensure patient pain is adequately treated, documented and monitored. Some of the key standards for hospitals include advising patients of their right to pain relief, asking patients to rank their pain level, and providing pain- management training for medical staff.

"From a nursing standpoint, it is thrilling. It's built into everything we do," said Judy Bethe, nursing quality-improvement manager at Hoag Memorial Hospital Presbyterian in Newport Beach.

PATIENTS' PAIN GETS CLOSER EXAMINATION

The standards, imposed last year by the Joint Commission on Accreditation of Healthcare Organizations, come as the health industry and federal and local lawmakers take a harder look at how medical providers treat pain.

Federal health agencies have increased funding for pain research, medical schools are making pain education a core part of curricula, and two years ago California declared pain assessment to be part of the state's health and safety code.

"We call it the fifth vital sign," said Dr. Gary Bennett, a pain-management specialist at Chapman Medical Center in Orange, one of the first hospitals in the county to offer a pain program.

National pain expert June Dahl said reversing the history of "undertreating" patient pain became a major priority in the health-care industry after a series of studies in the late 1990s. Some of the findings showed that nearly half of all pain sufferers said their pain was "out of control" and that physicians often did little to provide relief.

"Pain gets short-shrifted because the focus is on curing people of disease," said Dahl.

With the new standards in place, pain experts say, the health-care industry is experiencing a wave of reforms.

"This is only part of the entire movement that's sweeping the country that better pain care is desirable and achievable," said Dr. Philipp Lippe, executive medical director of the American Academy of Pain Medicine.

Medical experts point to a variety of reasons for the poor state of pain treatment, including a fear of narcotic addiction by both doctor and patient and a belief that pain is expected when you're sick or injured.

That's especially true for those with post-operative pain because doctors and patients are conditioned to believe that suffering is part of recovery, said Dr. Daniel Le, a pain specialist at Fountain Valley Regional Hospital.

"That's old-style thinking," Le said.

As far as addiction, Le said, "true" narcotic addiction is extremely rare if a physician properly weans a patient of a drug.

"Non-pain-management physicians should be less fearful of narcotics for pain control," he said.

Sometimes drugs are withheld

For some patients, like Mary Perrin, narcotics are often not an option because of physician reluctance.

After a car accident, the 53-year-old Orange resident said, she suffered severe neck and back pain. She had spinal surgery to correct the injury.

But weeks after the procedure, Perrin said, she remained incapacitated, unable to cook, garden or sit through a two-hour movie.

She told her surgeon, but he didn't believe her.

"He thought it was psychosomatic. Then he told me, 'When I fix something, it stays fixed,' " said Perrin, who remains in chronic pain and is now under Bennett's care.

Bennett and other pain specialists said some doctors are unaware of the nonsurgical methods of treating pain—a lack of knowledge that often leaves patients like Perrin to suffer unnecessarily.

To solve that problem, the commission is also requiring health-care organizations to provide training for staff so they can learn more about pain-treatment options.

Medical schools are also getting involved.

Many are improving pain-education courses, including UCI College of Medicine, which is developing a curriculum that embraces the idea that pain evaluation is part of a doctor's job.

"My hope is that (pain management) will be part of the culture of a doctor's practice—the same as taking a patient's history," said Dr. Alpesh Amin, co-director of the school's pain and palliative-care curriculum.

That can only mean good news for the millions of pain sufferers across the country.

"Pain patients are finally getting their day," said Bennett.

PAIN FACTS

More than 75 million Americans live with serious pain.
About 25 million people experience acute pain as a result of injuries or surgeries.
More than half of all individuals with moderate to chronic pain have been suffering for more than five years.
About 40 percent of those suffering from pain report that their pain is out of control.
Of the people whose pain is under control, about 46 percent say it took them more than a year to get relief.
More than half the people with very severe pain change doctors at least once; one-fourth of those change doctors three or more times.
Nearly 50 percent of those who change doctors frequently say they do so because they continue to have pain after treatment.
Nearly 70 percent of those suffering from severe pain have never been referred to pain specialists.
Pain is responsible for 4 billion lost workdays each year, resulting in a $79 billion loss to the economy.

NATIONAL STANDARDS

Eleven Orange County hospitals are up for accreditation this year. They must meet these new pain-management standards:

Inform patients and family members of right to pain assessment and appropriate pain treatment.
Regularly assess patients' pain, keep record of the pain to assure proper follow-up. Ask questions such as, "Do you have pain now?" "Have you had pain in the last several months?"
Give patients a tool to measure pain intensity, such as a scale of 0-10.
Make sure medical staff is educated in pain assessment and management.
Collect data to monitor effectiveness of pain-management program.
Address a patient's access to pain relief after discharge.