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    Isn't it time for a 21st Century Pain assessment?

     

    This mistake stems from recommendations, such as those from the Agency for Healthcare Research and Quality, whose position is that “patients’ self-reports are the most reliable indicator of their experiences of pain.”

    This line of reasoning is devoid of any objective measures and places the patients’ “self-reports” as the cornerstone in an acute pain management protocol. In addition, the reliance solely on the subjective measure of a patients’ self-report exposes providers to unnecessary legal consequences of under-treatment as well as opioid over-treatment resulting in possible respiratory morbidity, mortality or long-term addiction if this model is continued into the outpatient setting.

     

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    While the legal implications of the way practitioners assess and treat acute pain in the hospital and post discharge are beyond the scope of this article, it is important to note that hospitals, pharmaceutical companies and practitioners are being sued for mortalities related to the inappropriate prescriptive use of opioids.

    As for big pharma, their culpability lies in the inaccurate education and detailing of opioids as either not as addictive or not as dangerous as they truly are.

    The objective measures of pain and critical thinking of where a patient is relative to where they were or where they should be, is requisite prior to the patient’s self-report of whether they view their pain as tolerable or intolerable. When married together into a global pain matrix, these measures will guide the practitioner with the initiation, maintenance, escalation or de-escalation of analgesic therapy. In my experience, nurses feel that they will be reprimanded if they withhold analgesics from a patient who has rated their pain a nine out of 10 on the universal pain scale. This fear routinely leads to unintended consequences.

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    Myles Gart MD
    Myles Gart, MD, MMM, is a member of the ASA Committee on Professional Liability, president and CEO of gartmd.com and a practicing ...

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