Health care providers' liability exposure for inappropriate pain management
Courts may become increasingly inclined to include proper pain management in the "standard of care" ó the standard health providers must meet to avoid malpractice. A reason for this is the development and promulgation of pain management practice guidelines, such as the AHCPR Acute Pain Management Guidelines and Cancer Pain Management Guidelines.

Extensive research has shown that pain management practices are often inadequate. In one study of 454 inpatients, 79% had pain during hospitalization, and 58% of this subgroup described their pain as horrible or excruciating. Seventy-five percent of cancer patients have reported suffering pain, with 25% dying in severe, unrelieved pain. Over two-thirds of nursing home residents have serious pain. These findings are shocking, in light of the fact that pain can be controlled for many patients.

Two recent lawsuits show that good pain management is becoming a medical standard of care. In North Carolina, a jury awarded $15 million (later settled for an undisclosed sum) in damages to the family of a patient who suffered through pain mismanagement at the end of life. The Georgia Supreme Court affirmed a patientís right to receive medication to control pain, as well as the right to discontinue unwanted medical treatment. New statutes at the state level, institutional pain management guidelines, and the Pain Relief Act, developed by the Project on Legal Constraints on Access to Effective Pain Relief, a research project of the American Society of Law, Medicine & Ethics, will also broaden liability of professionals who mismanage pain. (Shapiro RS. J Law Medicine Ethics. 1996;24:360-364.)