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Feeling Your Pain
Hospitals have to treat agony. But now they must find the best measure of it
In a small valley between the rushing Clark Fork River and the towering Rocky Mountains lies Missoula, Mont. Long famous for its natural serenity, today it is becoming known for a different kind of peace, as a trailblazer in the ability to quell pain.
Three quarters of surgical patients in the United States say they get poor relief from acute pain. And among nearly 600 hospitalized cancer patients in a national study, nearly half weren't given enough painkillers. One of the chief reasons was that doctors tended to view pain as less severe than did the patients themselves. But this may be changing, thanks to techniques pioneered in Missoula and elsewhere that are now becoming a part of national hospital practice. The country's 18,000 hospitals, nursing homes, and other care facilities can no longer be accredited unless they measure pain as "the fifth vital sign"--monitoring and treating it as carefully as they do temperature, blood pressure, breathing, and pulse. "Our surveyors are out in the field now," says Russ Massaro, an executive vice president of the Joint Commission on Accreditation of Healthcare Organizations. "We intend that any patient in an accredited institution will receive scientific pain care."
To accomplish this, patients are being taught to rate their pain's origin, location, and intensity on a variety of scales, and staff members then chart the changes in intensity ratings every few hours, offering medication as needed. The latest compliance numbers just came in. In 2001, just 7 percent of facilities weren't up to snuff.
For patients, it's not just a matter of not hurting. Research has shown that when pain is controlled, people recover from illnesses more quickly and leave the hospital sooner. "Patients get better care with these assessments," says Charles Cleeland, director of the pain research group at M. D. Anderson Cancer Center in Houston. "For example, if you've had chest surgery and are in a lot of pain, you're not going to want to cough. So you're more likely to develop pneumonia" because gunk builds up in the lungs. That's life threatening. Pain ratings make it more likely that such agony will be noticed and treated with analgesics, and the chances of pneumonia go down with the pain.
Comfort index. When Linda Lewis checked into the University of Maryland Medical Center in Baltimore two weeks ago, she didn't know her pain was at an 8. That's on a scale where 0 at one end means no pain and 10 at the other end is the worst pain she could imagine. Lewis, a 54-year-old pharmacy technician in Cumberland, Md., "just knew it was excruciating, because I had a lung tumor that was pressing against my vocal cords and esophagus," she says. But hospital nurses explained the reason for the scale and told her they'd be asking her for numbers throughout her stay. If the pain got higher than a 4, they said, they'd ask other questions about its location and onset and whether it was sharp or dull, just to get a better handle on what was happening.
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