According to the article, several studies have demonstrated that pain is common in hospitalized patients, but pain treatment is often inadequate. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has developed a pain management program that must be implemented by all health care organizations to maintain complete accreditation, and requires that all patients admitted to a health care facility be covered by the facility's pain management program. These nonselective regulations are based on studies in hospitalized populations at high risk of pain. There is currently not enough data to support a nonselective approach to pain management in hospitals, and the widely applied JCAHO regulations may under serve certain patients most in need of pain management. By identifying patients at high or low risk for pain, it may be possible to improve the overall effectiveness of pain management and focus on patients at high risk for pain.
Chad T. Whelan, M.D., of the University of Chicago, and colleagues studied hospitalized patients to identify their pain levels and severity and looked for characteristics that could identify patients within the group who might be at low risk for pain. The researchers also measured patient satisfaction with pain management.
The researchers used data collected between July 1, 1997 and June 30, 2000 from 5,584 patients admitted to the general medicine inpatient service at an urban academic medical center. Characteristics including age, sex, educational level, and diagnosis were obtained from hospital administrative records. Patients were contacted by telephone 30 days after discharge and were asked about pain and pain control during their hospital stay.
The researchers found that of the study patients, 59 percent had pain (28 percent reported severe pain, 19 percent moderate pain, and 12 percent mild pain). Among patients with common diagnoses, those with complications arising from sickle cell disease were the most likely and those with syncope (temporary loss of consciousness or "fainting" episode) were the least likely to report significant pain (90 percent and 34 percent, respectively). Characteristics that were significantly associated with an increased risk of pain included specific diagnoses, weight, being older than 65 years, being female, and having an education level higher than high school.
The researchers also found that pain was reported by 28 percent of patients without high-risk characteristics for pain and 82.2 percent of patients were satisfied with their pain treatment, whereas 11.1 percent were somewhat satisfied, and 6.7 percent of patients were dissatisfied.
"We found that patients hospitalized in a general medicine service carry a heavy pain burden," write the authors. "A large percentage of our study patients had experienced pain, and a significant percentage was dissatisfied with the pain management that they had received. Our data for pain prevalence and severity closely resembled those reported for populations thought to be at high risk for pain. While we identified several predictors of pain, we were unable to identify a population truly at a low risk using these predictors. Therefore, it may be important to think of all patients hospitalized in general medicine services as being at high risk for pain, just as we do for patients with cancer and for critically ill and postoperative patients."
The researchers continue: "Patients' satisfaction with pain control is the key measure of success of a pain management system. We found that almost 20 percent of the patients who had experienced pain (representing about 10 percent of the total of the hospitalized population) were less than satisfied with pain management. While 10 percent may seem to be a small target for a systematic approach to improve quality, it represents a significantly larger group than patients with the most common primary diagnosis (asthma, 6.7 percent) in this population."
(Arch Intern Med. 2004;164:175-180. Available post-embargo at archinternmed.com)
Editor's Note: This study was supported by a grant from the Agency for Healthcare Research and Quality, and by the University of Chicago Hospitals.
To contact Chad T. Whelan, M.D., call John Easton at 773-702-6241. For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org .
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Archives of Internal Medicine