The Right to Quality Chronic Pain Management

Posted on Saturday, March the 15th at 1:55pm

By Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II

Today, chronic pain is one of the most critical healthcare issues in the world. In the United States alone, more than 100 million people suffer with some type of chronic pain—affecting 1 in 5 Americans.  Chronic pain takes its toll on personal lives, healthcare resources, and the economy—more than $100 billion in medical expenses and more than $70 billion each year in lost productivity, unsafe working conditions and increased absenteeism.

It is necessary for hospitals to comply with pain management standards put in place by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2001. However, it is now also mandated that addiction treatment and mental health centers that are accredited by JCAHO also adhere to these pain management standards which require healthcare providers to:

·          Recognize the right of patients to receive appropriate assessment and management of pain

·          Establish the existence of pain and assess its nature and intensity in all patients

·          Record the results of the assessment in a way that facilitates regular reassessment and follow-up

·          Determine and assure staff competency in pain assessment and management, and address pain assessment and management in the orientation of all new staff

·          Establish policies and procedures which support the appropriate prescription or ordering of effective pain medications

·          Educate patients and their families about effective pain management

·          Address patient needs for symptom management in the discharge planning process

I have found that many addiction and coexisting disorder treatment programs do not appropriately adhere to those standards due to the mistaken belief that when someone is in addiction recovery they should not take anything—no matter what! In addition, many treatment programs do not fall under the jurisdiction of JCAHO and therefore have no pain management standards to adhere to.

I want to list below the Seven Point Clinical Philosophy of Pain Management that I helped Sierra Tucson’s Pain Management Program to develop as they become the first Addiction-Free Pain Management™ Center of Excellence in the United States. I would like to suggest that all treatment programs develop similar philosophies for effective pain management.

1. We believe that each patient’s report of pain is valid. Our approach to assisting the patient is driven by this basic assumption.
   
2. We treat each patient with dignity, acknowledging their perception of pain and accepting their cultural, spiritual, and psychological values as their reality.
   
3. Our primary goal is to assist the patient in wisely and skillfully managing their pain experiences, based upon the patient’s stated desire for pain relief.
   
4. Given the nature of our facility—working with patients addicted to mood altering chemicals—addressing both patients’ pain and their addiction becomes a delicate balance. We will therefore work to complete a comprehensive pain assessment with reassessment at regular intervals taking into account a patient’s progress. This can only be accomplished using a multidisciplinary team approach.
   
5. Pain will be a component of the patient’s interdisciplinary treatment plan. We educate all clinicians to assure competence in dealing with the addicted patient whose treatment is complicated by coexisting pain issues.
   
6. Our role is that of advocate for the patient to assist him/her in achieving their recovery goal while providing relief of pain.
   
7. We have a committee for ongoing examination of our work treating patients with acute and/or chronic pain. If we determine that we are unable to adequately and safely treat a patient with co-occurring pain issues we will offer resources to the patient that may better address his/her pain needs.

To learn more about effective treatment for people with chronic pain and coexisting disorders please go to my publications page and consider purchasing my newest book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management™ System. Or you can contact me directly by email or phone 916-575-9961 to discuss how we could work together to implement the APM™ Treatment System and specify it for your treatment center or agency.