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HEALTHCARE SYSTEM CONTINUES TO UNDERTREAT
PAIN -- Numerous research studies have shown
that
"opiate" painkillers are seriously underused.
Story here...
http://www.mlive.com/news/grpress/
index.ssf?/base/features-1/1167752787107740.xml&coll=6
Story below:
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Health-care system continues to undertreat pain
By Howard Brody
The Grand Rapids Press
One of the continued scandals in American medicine is how poorly we
treat pain, especially in hospitals and nursing homes.
"Opiate" drugs, morphine and its cousins, are highly effective
painkillers. Their downside -- including side effects and dangers of
causing addiction -- has been shown scientifically to be modest when
they are used properly.
Yet numerous research studies have shown they are seriously underused,
and roughly a third to a half of patients with moderate to severe pain
never get relief.
So the Joint Commission (JCAHO), the 800-pound gorilla that reviews
American health-care facilities and beats them up if they are
substandard, recently announced a new program. The idea was if we could
just get nurses to be as obsessive about recording untreated pain as
they are about writing down the temperature and blood pressure, things
would improve.
If docs and nurses only knew how bad the pain was, surely they'd do
something. (They call this "pain as the fifth vital sign.")
In mid-2006, three major research studies of this new approach appeared
in major medical journals. Mount Sinai Hospital in New York, Monmouth
Medical Center in New Jersey and a large Veterans Administration
hospital on the West Coast made serious efforts to improve pain
management and measured what happened.
The hospitals did slightly different things, Monmouth making the least
complicated changes and Mount Sinai enacting the most, including a
computer program to help physicians make better decisions.
Monmouth reported no change -- nobody wrote down more information about
pain, no one gave more painkillers and no patients had better pain
relief.
At the VA and at Mount Sinai, the programs succeeded very well in
getting nurses to write down more pain reports. And at Mount Sinai, the
physicians prescribed more potent painkilling drugs.
No change
The only trouble was the patients' pain scores did not improve at any of
the hospitals.
The bottom line seems to be just knowing the patient is having pain
often does not mean we'll give the patient the needed medicine. And,
even when we do give the better medicine, we may not give enough or give
it often enough.
The United States has a deeply rooted aversion to drugs such as
morphine, which we associate with addiction. Apparently, we prefer
allowing dozens of hospital patients to writhe in misery, rather than
taking a chance that one addict someplace will get drugs.
Until those social attitudes change, I doubt the medical system, by
itself, will get much better at treating pain compassionately.
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Larry Scott
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