Patients suffering needlessly Report tells doctors to rethink dosages

A MANIFESTO ON ENDING PAIN

March 06, 1992|By Jonathan Bor | Jonathan Bor,Staff Writer

WASHINGTON — In a story about pain in The Sun yesterday, Ada Jacox, co-chair of a national panel on pain medication, was incorrectly identified as Ms. Jacox. Dr. Jacox, a registered nurse at the Johns Hopkins School of Nursing, has a Ph.D. in nursing.

The Sun regrets the errors.

WASHINGTON -- Millions of Americans suffer unacceptably high levels of pain after surgery each year because they receive too little or the wrong medication, according to a federal report released yesterday.

What's more, doctors have been equipped to prevent serious post-operative pain for the last 30 years. But, mired in outmoded attitudes toward pain, they have failed to reduce the rather dismal rate of needless suffering in U.S. hospitals, the report said. Releasing what amounts to a manifesto on pain management, a panel of physicians, nurses, pharmacists and ethicists called upon doctors to select drugs and doses capable of preventing their patients' pain -- rather than relying on the usual practice of giving injections to relieve pain once it flares.

FOR THE RECORD - CORRECTION

"What we're saying is that you should talk to patients ahead of time -- see how much pain they want to tolerate," said Ada Jacox, a registered nurse from the Johns Hopkins School of Nursing who co-chaired the 17-member panel.

Pumps that allow patients to give themselves small but frequent doses of pain medication without overdosing are safe tools that do not result in more drugs being used in the long run, the panel said.

"Patients are clearly more satisfied with these devices: their pain is better controlled, and there was a trend toward earlier discharge," said Dr. Daniel Carr, the panel's co-chairman who is director of pain management at Massachusetts General Hospital Boston.

Also, the committee called for an end to "myths," shared by doctors and patients alike, that have hindered progress on this front.

"I, for one, hope this guideline finally sets to rest the many myths that premature infants and other infants feel no pain, and do not need to be medicated for it, as well as the myth that less pain care is needed by the elderly because they have a higher pain threshold," Assistant Health Secretary James O. Mason said.

Some 23 million surgeries are performed each year, and morethan half are managed with "as needed" rather than preventive strategies of pain relief, the panel said. In half those cases, the patients experience moderate to severe levels of pain -- a statistic that hasn't changed in 30 years, Ms. Jacox said.

The panel also called on doctors to shed the groundless fear that patients will become addicted if they are given short courses of morphine, a medication that the panel called "the drug of choice" for post-operative pain control. Studies have shown that addiction is rare under these circumstances -- as low as 4 cases in 10,000, according to a Boston study.

Ms. Jacox said she hoped the guidelines would cause doctors and patients to discard the idea that pain is an inevitable consequence of surgery.

"Many patients have the attitude that you must be stoical," she said. Young men and little boys are taught to "grit their teeth and bear it," and women who complain about their pain are often regarded as neurotic and not taken seriously.

"The increased pain makes patients reluctant to cough and deep breathe and move about, which in turn places them more at risk forcomplications such as pneumonia and blood clots," Ms. Jacox said. Patients who feel little pain, she said, are able to get out of bed faster and walk -- activity that speeds recovery.

Dr. Mason projected that more effective pain management can shave a half-day off the average patient's hospital stay.

The guidelines will be distributed to physicians, nurses, medical and nursing societies, medical and nursing schools, insurance companies and consumer groups, according to the Department of Health and Human Services, which commissioned the panel.

While praising the self-dosing pumps, a device that was introduced in the mid-1980s, Ms. Jacox said doctors have long known how to control pain using more traditional methods.

Often, she said, pain can be controlled by more carefully selecting the appropriate drug as well as the doses and intervals at which they are given.

She said there are vast variations in methods of pain management from hospital to hospital -- even within institutions like Johns Hopkins Hospital, where certain specialists are making great strides toward easing their patients' discomfort.

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