Joint Statement on Pain Management
Pain management is a significant issue in health care
today. Estimates of Americans
experiencing pain range from 50-75 million persons annually. Thirty to fifty percent of patients
undergoing cancer treatment experience pain.
The effects of unmanaged pain are serious and wide-ranging and, yet,
pain is widely under-treated. Untreated
or inadequately treated pain impacts patients’ quality of life and increases
health care costs. Factors cited in the
under-treatment of pain include concerns about causing addiction or tolerance;
inadequate knowledge of controlled substances and pain management; fear of
scrutiny and discipline by regulatory agencies; inadequate assessment; and
patient reluctance to report pain or to take pain medications.
The Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) guidelines on pain management state, “Patients have the right
to appropriate assessment and management of pain.” (Emphasis added). It is, therefore, incumbent upon Minnesota physicians,
nurses and pharmacists to work cooperatively and effectively to address the
dimensions of pain and to provide maximum pain relief with minimal side
effects. Towards that end, and in the
interest of public protection, the Minnesota Boards of Medical Practice,
Nursing and Pharmacy issue the following joint statement.
To effectively assist patients in the management of pain,
health care professionals should, within their scope of practice:
- Consistently
and thoroughly assess all patients for pain. If pain is reported, the pain should be
evaluated with a complete history and physical with laboratory and
diagnostic testing, if indicated;
- Work
collaboratively in a multi-disciplinary approach to develop and implement
an individualized, written treatment plan utilizing pharmacologic and
non-pharmacologic interventions with specific objectives for the patient;
- Regularly
evaluate the effectiveness of the treatment plan, using a consistent,
developmentally appropriate, standardized pain scale, and make adjustments
as needed;
- Document
all aspects of pain assessment and care in a timely, clear, consistent,
complete and accurate manner;
- Anticipate
and effectively manage side effects of pain medications;
- Provide
adequate and culturally appropriate information to patients and family
members or caregivers to support patients in making informed decisions and
participate in the management of their pain;
- Be
aware of the risks of diversion and abuse of controlled substances and
take appropriate steps to minimize these risks;
- Recognize
individuals with chemical dependency may experience pain requiring
medications, including opioids, and may require specialized management;
- Consult
with, and refer patients to, other providers when appropriate;
- Develop
organization-appropriate and evidence-based policies and protocols for
pain management;
- Become
and remain knowledgeable regarding effective pain management; and
- Comply
with all state and federal laws and regulations regarding prescribing,
dispensing, and administering legend drugs, including controlled
substances.
Resources:
American Pain Foundation
201 North
Charles Street, Suite 710
Baltimore,
MD 21201-4111
1-888-615-PAIN (7246)
www.painfoundation.org
American Pain Society
www.ampainsoc.org
DEA
www.deadiversion.usdoj.gov/faq/pain_meds_faqs.pdf
Federation of State Medical Boards: Model Policy for use of Controlled Substances
for the Treatment of Pain.
www.fsmb.org
“Guideline for Pain Management.” Kansas State
Board of Nursing (2001).
“Joint Statement on Pain Management in End-of-Life
Care.” North Carolina Boards of Nursing, Pharmacy
and Medicine (1999).
“MNA Position Statement:
Pain Management.” Minnesota Nurses
Association, (2000).
www.painandhealth.org
“Pain Management Policy.”
California
Board of Registered Nursing. (1999)
“Position Statement on Pain Management and Control of
Distressing Symptoms in Dying Patients.”
American Nurses Association.
(2003).