Physicians challenged to deliver appropriate, effective pain management
"Given the many chronic diseases that physicians cannot do much about, it is puzzling that more physicians do not do a better job at relieving pain. Not only is it something that is generally straightforward to achieve but sometimes it's the only meaningful therapy we can offer our patients." Jay Siwek, MD, chairman of the department of family medicine, Georgetown University School of Medicine

A survey of over 7000 studies by the Agency for Healthcare Research and Quality (formerly the Agency for Healthcare Policy and Research) showed that half of all patients given conventional therapy for pain — and most of the 23 million annual surgical cases — do not get adequate relief. There are many barriers to effective pain management (see Table). Research has also shown that:

Use of prn pain medicine delays pain relief
Pain prevention is better than treatment as pain arises
Patients have the right to adequate pain control and pain control plans
Fears of postsurgical addiction to opioids are generally unfounded
Proper pain management is patient-centered; according to the American Pain Society (APS), patients' reports of unrelieved pain should be honored. Other APS guidelines suggest that clinicians keep analgesic information in the place where orders are written, promise patients pain control, urge patients to communicate their pain, implement policies and safeguards for modern analgesia, and assess pain management practices. By way of example, when staff at the Bay Area Medical Center in Marinette, Wisconsin, developed a comprehensive surgical pain management program, patient satisfaction ranking for pain control improved. (The Quality Indicator. September, 2000:10-12.)

Obstacles to Pain Relief
Not prescribing enough pain medication
Not using around-the-clock, scheduled dosing
Not using PCA systems when indicated
Using the wrong route of analgesia
Not using adjunctive treatment, or using it inappropriately
Increasing dose frequency instead of total dose itself
Not using analgesics preventively, in anticipation of pain
Not using additional short-acting medication for breakthrough pain
Not checking to see if pain medications are taken as ordered
Not adequately assessing pain
Adapted from the Quality Indicator. September 2000:10-12.
http://www.partnersagainstpain.com/html/profed/pmc/pe_pmc4.htm?pg=6302§ion=pe_pmc4