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Patient Pain Gets More Attention.


Some hospitals already have patient-based systems in place; common measuring systems are "happy face/sad face" or "1-10" pain severity charts. At Washington Hospital Center, Rhodes says, "At least every 8 hours, inpatients have their pain rated. ... Every time an outpatient comes through one of our clinics, the pain is rated. Zero is no pain. Ten is the worst pain imaginable. It is what the patient says, not what the physician or nurse feels that the pain rating should be."

Rhodes tells WebMD that her hospital also gives patients pain education information upon admission, "so they understand that they have a right to pain management and that they also are informed of their pain treatment options."

Last year, the commission first measured hospitals' pain programs, but didn't score them for accreditation. This year, the grades will count in whether a hospital keeps its accreditation. Schyve won't say how the hospitals did in 2000, but he tells WebMD, "There were certainly a good portion of hospitals that were able to meet the standards quite successfully. It became very clear that these are standards that a hospital can meet."

But Wolf thinks that hospitals may still have compliance troubles, given that the medical culture has given pain care short shrift.

"In allowing treatment of chronic ... pain to be included as a 'patients' rights' issue, physicians may be pressured to prescribe opiates in cases in which this is inappropriate," wrote San Gorgonio Memorial Hospital's George Hansen, MD, in a letter to The Journal of the American Medical Association last November. "Patients with chronic pain are at substantial risk for drug abuse and addiction."

Richard Frankenstein, MD, a JCAHO official, responded, "Flawed conceptions about addiction, tolerance, and dependence ... must be dispelled."

In fact, according to a study published last April in The Journal of the American Medical Association, an increased use of morphine for pain control during the past decade did not cause increased drug abuse.

In that study, David E. Joranson and colleagues at the University of Wisconsin Medical School in Madison found that medical prescriptions for opioids, or morphine-like drugs derived from the opium poppy plant, increased from 1990 to 1996. However, cases involving abuse of these drugs dropped from just over 5% of all drug abuse cases to 3.8% during that same time.

"The major implication of our study is that there is no support for the fear that opioid abuse would increase if the appropriate medical use of opioids increases," Joranson told WebMD in April.

Finally, Schyve points out another roadblock that patients in particular must overcome. "Patients have simply assumed that pain is part of their illness, or pain is part of the healing process, and haven't come forth and talked about the pain and asked for it to be relieved," he tells WebMD.


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