Improving the practice of pain management
Inadequate pain management is "a systems issue," for which physicians should not be held solely responsible. The new pain standards from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) will serve to stimulate an interdisciplinary approach to pain management and assessment, marked by greater sharing of responsibility for implementation of pain protocols. The administrative "rules" that emerge as institutions implement the standards may in fact restructure the physician's work environment.

Physicians have often been blamed for the undertreatment of acute and chronic pain. In addition to failing to assess patients' pain, studies have shown physicians may prescribe inappropriate drugs at inadequate doses at incorrect intervals. If opioids are required, physicians fear overtreating patients, and are often reluctant to prescribe for fear of regulatory scrutiny and adverse effects, especially tolerance, addiction and respiratory depression. Educational initiatives for physicians on pain management, including CME and clinical practice guidelines, have had limited success.

"One would hope that worries about undertreatment or overtreatment would not dominate the practice of pain management," says June Dahl, PhD, of the University of Wisconsin-Madison Medical School. "Physicians should instead base treatment decisions on the scientific and medical evidence that is available from many sources. It is time for physicians, nurses, pharmacists, other health care professionals, system administrators, and regulators to come together to ensure improved function and good quality of life for all persons in pain." (Dahl JL. JAMA. 2000;284(21):2785.)