Health Officials Call for Less Aggressive Treatment of Pain
Amid alarm over painkiller addiction, letter seeks stricter approach in hospitals and clinics
By Jeanne Whalen
Dallas, TX | Posted April 18, 2016
In a sign of growing alarm about painkiller addiction, a group of U.S. state health officials, doctors and consumer advocates is calling for a stricter approach to treating pain in hospitals and clinics.
The group of 60, including senior health officials from Pennsylvania, Vermont, Alaska and Rhode Island, is recommending new guidelines for pain treatment, saying current standards are too aggressive and contribute to overuse of addictive painkillers.
In a letter sent Wednesday to the head of the Centers for Medicare and Medicaid Services, the group urges the agency to stop surveying patients about how well their pain was controlled while in the hospital, a set of questions the agency uses to help judge hospital performance and determine payment. The group argued that the pain questions “have had the unintended consequence of encouraging aggressive opioid use” because hospitals aim for high scores on the surveys.
CMS said it would respond to the letter. It added that the Department of Health and Human Services, which oversees CMS, already announced in October it would review how hospitals’ patient satisfaction surveys influence pain treatment and opioid prescribing.
In a separate letter, the health officials and doctors are asking a nonprofit body that accredits hospitals and clinics to “re-examine” the pain management standards it requires its accredited institutions to follow. The letter to the president of the Joint Commission, a body funded by the health-care industry, says these standards “encourage unnecessary, unhelpful and unsafe pain treatments.”
The letters add to a growing chorus of concern about addiction to prescription opioid painkillers and heroin, a chemically similar drug. President Barack Obama and members of Congress have proposed measures to combat the crisis, which health officials say is causing more Americans to die from drug overdoses than from traffic accidents.
The Joint Commission standards for treating pain, adopted in 2001, require hospitals and clinics to assess and manage pain as part of their routine care. The Joint Commission developed the standards amid concern in the 1990s that too many doctors and nurses were neglecting pain, David Baker, executive vice president of the Joint Commission, said.
“There was a time where pain wasn’t assessed,” Dr. Baker said, noting that when he worked as an internist at a University of California, Los Angeles teaching hospital in the early 1990s, he saw a patient with metastatic cancer who wasn’t receiving pain medication because no one asked him about his pain levels, which were high.
The original 2001 standards required hospitals to assess and regularly reassess pain in all patients. The standards declared this a patient “right.”
Dr. Baker said the Joint Commission has dialed back some of the language over the years in response to criticism. The current language mandates that a hospital “assesses and manages the patient’s pain,” among other steps.
Dr. Baker said the Joint Commission has been considering “what can we do to decrease inappropriate opioid use.” He added, “Everybody recognizes what a hugely important problem this is.”
In an interview, Karen Murphy, Pennsylvania’s secretary of health, said she signed the letters because opioid addiction is causing “the worst public-health crisis I have ever seen in my career.” About seven Pennsylvanians die each day from opioid overdoses, she said.
Harry Chen, commissioner of Vermont’s Department of Health, who also signed the letters, said pain treatment has become “irrational.”
“I was a practicing emergency-room physician for 30 years. To point out how irrational it was, you actually had to wake people up to ask them how their pain was,” he said, referring to mandatory hospital policy.
An advocacy group called Physicians for Responsible Opioid Prescribing organized the letter-writing campaign.