The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has developed a pain management program that hospitals must implement in order to maintain JCAHO accreditation. Moreover, JCAHO requires that all patients admitted to a hospital be covered by the hospital's pain management program, not just those considered at high risk of pain such as cancer or surgery patients. This approach is a reasonable one, according to a study supported in part by the Agency for Healthcare Research and Quality (HS10597). It found that pain was common, even in hospitalized patients considered to be at the lowest risk for pain, and that individual factors could not predict who would be at high risk for pain.
Researchers from the University of Chicago studied 5,584 patients who were admitted to the general medicine inpatient service of a single urban academic medical center at some point over a 3-year period (July 1, 1997-June 30, 2000). They assessed the patients' pain and pain control in a followup telephone survey 1 month after hospital discharge and determined pain predictors through administrative databases and the patient survey. Overall, 59 percent of the patients suffered pain (28 percent severe, 19 percent moderate, and 12 percent mild). The pain prevalence and severity data for this study closely resembled data reported for populations thought to be at high risk for pain.
Nearly one in five patients (18 percent) were dissatisfied with their pain control. Certain patient characteristics were associated with pain or dissatisfaction with pain control, including diagnosis, number of coexisting illnesses, and age. However, the researchers were unable to identify a population truly at low pain risk using these predictors. Thus, as the JCAHO policy suggests, it may be important to consider all patients hospitalized in general medicine services as being at high risk for pain, conclude the researchers.
See "Pain and satisfaction with pain control in hospitalized medical patients: No such thing as low risk," by Chad T. Whelan, M.D., Lei Jin, M.S., and David Meltzer, M.D., Ph.D., in the January 26, 2004, Archives of Internal Medicine 164, pp. 175-180.