Pain and Satisfaction With Pain Control in Hospitalized Medical Patients

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Abstract
The recognition and treatment of pain in hospitalized patients has recently received increased attention. Several studies have demonstrated that pain is common and pain treatment inadequate.1-4 In response to these findings, many major health care organizations have made concerted efforts to improve pain management strategies.5-8 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. Moreover, JCAHO requires that all patients admitted to a health care facility be covered by the facility's pain management program.8 Organizations such as JCAHO have based these nonselective regulations on data from studies in hospitalized populations at high risk for pain. Most hospitalized patients with cancer as well as postsurgical and critically ill patients experience pain, which justifies a broad systematic approach to pain management.1,2,4,9-11 While these studies support a universal approach to pain management in populations at high risk for pain, no adequate data justify a nonselective approach. Obtaining data supporting a nonselective approach to pain management is important, however, because a widely applied systematic approach risks missing certain populations at high risk, and, therefore, the worsening of pain management practices for those who are the most in need. Thus, by risk-stratifying patients from a sufficiently large group at low risk for pain, it may be possible to improve the overall effectiveness of pain management programs and focus on patients who are the most at risk. We attempted to identify a population of hospitalized patients of sufficiently large size and low risk to cause JCAHO and other similar organizations to reconsider their use of a nonselective approach to pain management.