FW: Hospitals Told To Treat Pain

[Guest guest]

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(http://news.excite.com/news/ap/001225/12/easing-pain)

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News Article: Hospitals Told To Treat Pain

<SMALL><I>By LAURAN NEERGAARD, AP Medical Writer</I></SMALL>

WASHINGTON (AP) - When you enter a hospital, you have a right to

have your pain properly treated.

That sounds so common-sense, yet millions of Americans suffer

every day because pain is routinely ignored or undertreated.

But starting next week, the nation's hospitals must make a major

change: New standards require that every patient's pain be measured

regularly from the time they check in - just like other vital signs

are measured - and proper pain relief begun or the hospitals risk

losing their accreditation.

Patients should expect at least to be asked to rate how they're

feeling, from zero, no pain, to 10, the worst pain imaginable.

(Small children will use pictures to rate pain.) The score

determines what steps the hospital must take to help.

To stress how important the changes are, the new standards

actually put in writing that " patients have the right " to proper

pain assessment and treatment.

Some hospitals already are handing out leaflets and posting

signs in the halls telling patients about that right, so they know

it's OK - nay, crucial - to complain if a doctor or nurse doesn't

help.

Better, it's not just hospitals that must take the new steps but

nursing homes and outpatient clinics accredited by the Joint

Commission on Accreditation of Healthcare Organizations. The

commission adopted the standards over a year ago, but gave

facilities until January to comply.

It's " a watershed event, " said Dr. Portenoy, pain

medicine chairman of New York's Beth Israel Medical Center. " No

one has ever promised patients no pain. But what JCAHO wants to do

is promise people their pain will be assessed and managed in a

state-of-the-art way. "

Many centers still are scrambling to comply. Teaching health

workers who aren't pain specialists how to treat can take some time

- and many doctors inappropriately shun narcotics, a treatment

mainstay for numerous types of pain, because they think patients

will get hooked on them.

" This is not going to happen overnight, " cautioned American

Pain Society president-elect Miaskowski, nursing chair at

the University of California, San Francisco.

" Patients are going to have to demand better care, " she said.

" Unrelieved pain has negative effects. Just like they need an

antibiotic to treat infection, they need analgesics to treat their

pain. "

But many patients don't know they don't have to suffer - or that

pain is more than bothersome, it actually hinders healing.

So being a stoic isn't good. Revealing how much pain you're in

doesn't " bother the doctors " or distract them from treating your

underlying disease, common excuses.

" People think it's like an 11th commandment: 'Thou had surgery,

thou should have pain.' ... Or that if you have cancer, you must

have pain, " said June Dahl, a University of Wisconsin pain

specialist who helped write the standards. " Pain can be

relieved. "

How big is the problem? Cancer provides the best estimates:

About 40 percent of cancer patients have undertreated pain. One in

four elderly cancer patients in nursing homes receives no treatment

at all for daily pain. Last year, Oregon's medical board

disciplined a doctor for treating a dying cancer patient's pain

with mere Tylenol.

Look beyond hospitals and some 9 percent of Americans suffer

chronic pain, ranging from back injuries to rheumatoid arthritis.

Experts say four of every 10 with moderate to severe pain don't get

adequate relief.

One of the biggest challenges is teaching nonspecialists that

narcotic painkillers called opioids - such as morphine, codeine,

fentanyl - are the mainstay for many types of pain, Portenoy says.

Many doctors hesitate to prescribe opioids, which are heavily

regulated because they can be abused by addicts. But for people who

have never abused drugs and have no history of psychological

problems, hardly any become dependent on pain medicine, Miaskowski

said.

Another complaint, heavy sedation, usually wanes in three to

four days, she said.

So what's state-of-the-art treatment? For moderate to severe

pain from acute illness or surgery, expect a short-acting opioid

like Percocet, or morphine in a patient-controlled quick-dose pump.

For cancer, expect a long-acting version of morphine or oxycodone,

or a fentanyl skin patch.

For chronic pain not due to cancer, new guidelines recommend

similar opioids.

Methadone is an alternative when those drugs fail.

Doctors also are trying antidepressants and antiseizure drugs

like gabapentin for patients with nerve-related pain.

And relaxation and hypnosis help, too - but shouldn't replace

proper medication, Miaskowski stresses.

---

EDITOR'S NOTE - n Neergaard covers health and medical

issues for The Associated Press in Washington.

----

On the Net:

American Pain Society: <A HREF=http://www.ampainsoc.org>http://<A

HREF=http://www.ampainsoc.org>www.ampainsoc.org</A></A>

Joint Commission on Accreditation of Healthcare Organizations:

<A HREF=http://www.jcaho.org>http://<A

HREF=http://www.jcaho.org>www.jcaho.org</A></A>

[Guest guest]

This is GREAT news guys...I can't believe what I'm reading!!

It's about time somebody stuck up for the rights of pain sufferers

everywhere. My wife's been dealing with pain (back, headache) for

years, and we've tried almost everything you can think of. It makes

me feel good that now we have something to look back on and

say...hey...can you not do this??/ You have no idea how many

physicians have made her feel like less than a person just because

they can't or don't want to adequately manage her pain.

>

> -----------------------------------------------

> This Excite News Article

> (http://news.excite.com/news/ap/001225/12/easing-pain)

> has been sent to you from malouf@a...

> -----------------------------------------------

>

> News Article: Hospitals Told To Treat Pain

>

> <SMALL><I>By LAURAN NEERGAARD, AP Medical Writer</I></SMALL>

>

> WASHINGTON (AP) - When you enter a hospital, you have a right to

> have your pain properly treated.

>

> That sounds so common-sense, yet millions of Americans suffer

> every day because pain is routinely ignored or undertreated.

>

> But starting next week, the nation's hospitals must make a major

> change: New standards require that every patient's pain be measured

> regularly from the time they check in - just like other vital signs

> are measured - and proper pain relief begun or the hospitals risk

> losing their accreditation.

>

> Patients should expect at least to be asked to rate how they're

> feeling, from zero, no pain, to 10, the worst pain imaginable.

> (Small children will use pictures to rate pain.) The score

> determines what steps the hospital must take to help.

>

> To stress how important the changes are, the new standards

> actually put in writing that " patients have the right " to proper

> pain assessment and treatment.

>

> Some hospitals already are handing out leaflets and posting

> signs in the halls telling patients about that right, so they know

> it's OK - nay, crucial - to complain if a doctor or nurse doesn't

> help.

>

> Better, it's not just hospitals that must take the new steps but

> nursing homes and outpatient clinics accredited by the Joint

> Commission on Accreditation of Healthcare Organizations. The

> commission adopted the standards over a year ago, but gave

> facilities until January to comply.

>

> It's " a watershed event, " said Dr. Portenoy, pain

> medicine chairman of New York's Beth Israel Medical Center. " No

> one has ever promised patients no pain. But what JCAHO wants to do

> is promise people their pain will be assessed and managed in a

> state-of-the-art way. "

>

> Many centers still are scrambling to comply. Teaching health

> workers who aren't pain specialists how to treat can take some time

> - and many doctors inappropriately shun narcotics, a treatment

> mainstay for numerous types of pain, because they think patients

> will get hooked on them.

>

> " This is not going to happen overnight, " cautioned American

> Pain Society president-elect Miaskowski, nursing chair at

> the University of California, San Francisco.

>

> " Patients are going to have to demand better care, " she said.

> " Unrelieved pain has negative effects. Just like they need an

> antibiotic to treat infection, they need analgesics to treat their

> pain. "

>

> But many patients don't know they don't have to suffer - or that

> pain is more than bothersome, it actually hinders healing.

>

> So being a stoic isn't good. Revealing how much pain you're in

> doesn't " bother the doctors " or distract them from treating your

> underlying disease, common excuses.

>

> " People think it's like an 11th commandment: 'Thou had surgery,

> thou should have pain.' ... Or that if you have cancer, you must

> have pain, " said June Dahl, a University of Wisconsin pain

> specialist who helped write the standards. " Pain can be

> relieved. "

>

> How big is the problem? Cancer provides the best estimates:

> About 40 percent of cancer patients have undertreated pain. One in

> four elderly cancer patients in nursing homes receives no treatment

> at all for daily pain. Last year, Oregon's medical board

> disciplined a doctor for treating a dying cancer patient's pain

> with mere Tylenol.

>

> Look beyond hospitals and some 9 percent of Americans suffer

> chronic pain, ranging from back injuries to rheumatoid arthritis.

> Experts say four of every 10 with moderate to severe pain don't get

> adequate relief.

>

> One of the biggest challenges is teaching nonspecialists that

> narcotic painkillers called opioids - such as morphine, codeine,

> fentanyl - are the mainstay for many types of pain, Portenoy says.

>

> Many doctors hesitate to prescribe opioids, which are heavily

> regulated because they can be abused by addicts. But for people who

> have never abused drugs and have no history of psychological

> problems, hardly any become dependent on pain medicine, Miaskowski

> said.

>

> Another complaint, heavy sedation, usually wanes in three to

> four days, she said.

>

> So what's state-of-the-art treatment? For moderate to severe

> pain from acute illness or surgery, expect a short-acting opioid

> like Percocet, or morphine in a patient-controlled quick-dose pump.

> For cancer, expect a long-acting version of morphine or oxycodone,

> or a fentanyl skin patch.

>

> For chronic pain not due to cancer, new guidelines recommend

> similar opioids.

>

> Methadone is an alternative when those drugs fail.

>

> Doctors also are trying antidepressants and antiseizure drugs

> like gabapentin for patients with nerve-related pain.

>

> And relaxation and hypnosis help, too - but shouldn't replace

> proper medication, Miaskowski stresses.

>

> ---

>

> EDITOR'S NOTE - n Neergaard covers health and medical

> issues for The Associated Press in Washington.

>

> ----

>

> On the Net:

>

> American Pain Society: <A HREF=http://www.ampainsoc.org>http://<A

> HREF=http://www.ampainsoc.org>www.ampainsoc.org</A></A>

>

> Joint Commission on Accreditation of Healthcare Organizations:

> <A HREF=http://www.jcaho.org>http://<A

> HREF=http://www.jcaho.org>www.jcaho.org</A></A>

[Guest guest]

Gee...that looked a lot better when I typed it. If you're interested in a

cleaner version please e-mail me privately and I'll send it to you.

Ed Strout, Educational Development Coordinator

Austin EMS

Ofc.

Pgr.

ed.strout@...

Re: [texasems-L] Re: FW: Hospitals Told To

Treat

Pain

(Note: I am joking) But , we all know your wife is

faking it!

She is

just a drug seeker and we refuse to cater to her desire to

get high!

How many of your have heard that statement in the ED (or

elsewhere)

concerning a patient with a c/c of 'migraine'?

The worst (worse?) thing about this regulation is the 'page

of

faces' (what

I call it) we are supposed to show children who cannot

understand

the 1-10

scale and ask them to point to the face that best shows how

they

feel. I did

a little 'study' in my ED and asked the child visitors to

point to

the face

showing how they felt. (I even read the 'operating

instructions'

each time

before I did it just to make sure I was doing it right) More

kids

pointed to

the icky face than any other. Why? " Because we/I am at the

doctors

office " .

Kids have " White coat syndrome " more than adults. Why?

Because we

keep

giving them shots! The first thing my 5 year old asks when

he goes

to the

doctor is, " Do I have to get a shot? " I am not sure this

JCAHO thing

is

going to work the way all the nurses think it should.

Just my not so humble opinion,

Webb

Flame away all.

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