Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform.
The opioid crisis has been prominent in the news for the past several years. There is no question that the rising rates of opioid deaths, addictions, and disabilities have reached an epidemic level. At this point in time, adjustments need to be made to curtail the crisis and prevent any recurrence. Ultimately we must learn from any mistakes.
As a physician who has practiced medicine for nearly 40 years, it has impressed me that patients are not reluctant to complain about pain. As such, I was always perplexed by the movement in the early 1990s to make pain management a fundamental human right. In my experience, treating pain complaints has always been part of primary care management. However, there has always been some caution in the use of opioids because of a fear of addiction. In the early 1990s, some pain management specialists suggested that opioids could be more liberally used to treat chronic pain and that in this area they have a very low risk of addiction.
In 2001, the Joint Commission introduced a new requirement for all its accredited facilities that all patients needed to be screened for pain. Joint Commission accredited facilities can include hospitals, rehab facilities, nursing homes, imaging centers, home care agencies, sleep centers, and urgent care centers. Many physicians feel this mandate further fueled the increase in opioid prescriptions and subsequent abuse.
In defense of these allegations, in April 2016 the Joint Commission presented a statement entitled, “The Joint Commission Pain Standards: Five misconceptions.” Several of these proposed misconceptions are a bit difficult to swallow. Here are three of them:
Misconception #1: “The Joint Commission endorses pain as a vital sign.”
They state that the Joint Commission never endorsed pain as a vital sign. However, in December 2001, the Joint Commission together with the National Pharmaceutical Council presented a 101-page documented entitled, “Pain: Current understanding of assessment, management, and treatment.” They made the following statements on page 21.
“In 1996 the American Pain Society (APS) introduced the phrase ‘pain as the fifth vital sign’. This initiative emphasizes that pain assessment is as important as assessment of the standard four vital signs and clinicians need to take action when patients report pain. The Veterans Health Administration recognized the value of such an approach and included pain as the fifth vital sign in their national pain management strategy.”
Obviously, they appear to be condoning pain as the fifth vital sign, especially with the statement that the Veterans Health Administration recognized the value of pain as the fifth vital sign. Also, in its initial pain standards of 2001, pain needed to be assessed in all patients in all accredited facilities. That would imply that any warm, breathing body with a pulse and blood pressure needed to be assessed for pain. Ergo, pain was right in there with those vital signs.