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Pain: Current Understanding of Assessment, Management, and Treatments NATIONAL PHARMACEUTICAL COUNCIL, INC This monograph was developed by NPC as part of a collaborative project with JCAHO. December 2001 DISCLAIMER: This monograph was developed by the National Pharmaceutical Council (NPC) for which it is solely responsible. Another monograph related to measuring and improving performance in pain management was developed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for which it is solely responsible. The two monographs were produced under a collaborative project between NPC and JCAHO and are jointly distributed. The goal of the collaborative project is to improve the quality of pain management in health care organizations. This monograph is designed for informational purposes only and is not intended as a substitute for medical or professional advice. Readers are urged to consult a qualified health care professional before making decisions on any specific matter, particularly if it involves clinical practice. The inclusion of any reference in this monograph should not be construed as an endorsement of any of the treatments, programs or other information discussed therein. NPC has worked to ensure that this monograph contains useful information, but this monograph is not intended as a comprehensive source of all relevant information. In addition, because the information contain herein is derived from many sources, NPC cannot guarantee that the information is completely accurate or error free. NPC is not responsible for any claims or losses arising from the use of, or from any errors or omissions in, this monograph. A. I NTRODUCTION After years of neglect, issues of pain assessment and management have captured the attention of both health care professionals and the public. Factors that prompted such attention include the high prevalence of pain, continuing evidence that pain is undertreated, and a growing awareness of the adverse consequences of inadequately managed pain. Pain is common. About 9 in 10 Americans regularly suffer from pain,1 and pain is the most common reason individuals seek health care.2 Each year, an estimated 25 million Americans experience acute pain due to injury or surgery and another 50 million suffer chronic pain.3,4 Chronic pain is the most common cause of longterm disability, and almost one third of all Americans will experience severe chronic pain at some point in their lives.5 As the population ages, the number of people who will need treatment for pain from back disorders, degenerative joint diseases, rheumatologic conditions, visceral diseases, and cancer is expected to rise.5 Pain is often undertreated. Improved understanding of pain mechanisms has advanced treatment for pain. Sufficient knowledge and resources exist to manage pain in an estimated 90% of individuals with acute or cancer pain.6 Safe and effective medical treatment for many types of chronic pain also is available.7 Yet recent studies, reports, and a position statement2,8-9 suggest that many types of pain (e.g., postoperative pain, cancer pain, chronic noncancer pain) and patient populations (e.g., elderly patients, children, minorities, substance abusers)10-11 are undertreated. Data from a 1999 survey suggest that only 1 in 4 individuals with pain receive appropriate therapy.4,12 Inadequate pain management has adverse consequences. The adverse consequences of undertreated pain are considerable. Poorly managed acute pain may cause serious medical complications (e.g., pneumonia, deep venous thrombosis), impair recovery from injury or procedures, and/or progress to chronic pain.13 Undertreated chronic pain can impair an individual’s ability to carry out daily activities and diminish quality of life.14 In addition to disability, undertreated pain causes significant suffering. Individuals with poorly controlled pain may experience anxiety, fear, anger, or depression.15 Pain is also a major cause of work absenteeism, underemployment, and unemployment.2 Mounting health care costs and disability compensation reflect, in part, poor care for painrelated conditions.16 Thus, undertreated pain has significant physical, psychological, and financial consequences. The undertreatment of pain is not a new problem. The Agency for Health Care Policy and Research (AHCPR)a published the first clinical practice guideline (CPG) for pain management in 1992. The authors of this guideline acknowledged the prior efforts of multiple health care disciplines (e.g., surgery, anesthesiology, nursing) and pain management groups (e.g., American Pain Society, International Association for the Study of Pain) to address this situation.13 Multiple groups have subsequently produced CPGs that address the management of many types of pain. The recently introduced Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards for pain assessment and management17 represent a giant step forward in improving pain management.b To facilitate these
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