Susan Wolf was thought of as an addict. Pharmacists in Chapel Hill, N.C., winced when they saw her coming. She was known for scamming Percocet and Lortab from every doctor and pharmacy she could.
It was the only way she knew to find relief from the incapacitating pain of rheumatoid arthritis. On the verge of suicide, Wolf found a new doctor who understood her plight. The doctor gave Wolf 200 Percocets, so she no longer had to scramble for an effective painkiller.
"By getting my pain under control, I found I could drive, I could work, I could swim every day," Wolf said.
Now 42, Wolf is an ambassador for effective pain management. She told her story at a "leadership summit" on pain last week in Chicago, put on by the Joint Commission on Accreditation of Healthcare Organizations and the American Pain Society.
If attendance at the seminar is any indication, pain has finally arrived as a major quality issue in U.S. healthcare, up there with medical errors and patient restraints. Nearly 500 hospital managers, nurses, physicians and psychologists attended the May 22 session. The seminar will be repeated in Los Angeles on July 31.
Hospitals and healthcare organizations will soon have to meet new pain management standards set by the JCAHO.
Under the new standards, every patient must be assessed or screened for pain at admission, even if staffers don't think the patient has pain. The patient must be reassessed regularly during treatment. Pain management also is introduced into discharge planning. Organizations must standardize their internal practices and use clinical practice guidelines in certain settings.
Pain management is not included in a hospital's final JCAHO accreditation score, and Type I recommendations are not being issued. Pain management might become a Type I on Jan. 1, 2001.
Richard Frankenstein, M.D., an American Medical Association representative to the Joint Commission's Board of Commissioners, led the effort to develop new standards. "The new standards have an extensive basis of scientific background, more so than other standards," he said. "Many technical support committees and reviews had input."
The American Pain Society approached the JCAHO for a second time, in 1997, with a request for a pain standard that had already been rejected. This time the society was supported by the University of Wisconsin-Madison Medical School and the Robert Wood Johnson Foundation. The final standard was adopted in mid-1999.
Re-educating the healthcare workforce to take pain seriously is a huge challenge. Many physicians worry that the new standard will force them to issue opioid medications to real drug addicts.
"This came up at every step along the way," Frankenstein said. "The right is to assessment and medically appropriate treatment. The standard is not for drugs on demand." So far JCAHO surveyors are impressed with the variety of innovative approaches they're seeing in the field, Frankenstein said.