GUIDELINES HELP PUT FOCUS ON PAIN PATIENTS NEED TREATMENT FOR MORE THAN
INJURIES

New national guidelines should help patients get stronger treatment for pain.

Ironically, the new standards shouldn't have as much impact locally because
University Hospital has been in front of efforts to manage pain more
aggressively.

"We have lots of ambiguous feelings about pain," Dr. June Dahl, a
UW-Madison Medical School pharmacology professor, said Tuesday. "We don't
admire wimps. We think we ought to be strong."

New standards encourage hospitals to assess pain and treat it aggressively
as opposed to treating injuries alone.

"The problem is that people who suffer from pain, their family members and
health-care providers don't realize how bad pain is for us," Dahl said.

Midwestern Germans and Scandinavians, she said, admire stoicism and the
ability to put up with pain.

"Others believe that the pain they are experiencing is what they deserve
because they have not been good," she said. "A few people believe it is the
way to salvation."

Dahl led the group that developed the new standards about to published by
the Joint Commission on Accreditation of Healthcare Organizations.

"If you think about how the health-care system works in this country, we
really follow an acute care model focused on injury, disease or surgery,"
said Dahl. "In that context, pain can get short shrift."

The problem with pain, she said, is that it can't be measured by an
instrument.

In addition, Debra Gordon, a senior clinical nurse specialist who has
helped lead a pain management group at University Hospital, said
health-care providers have long thought that opiates used to relieve pain
are addictive.

"But recent evidence shows the risk of developing addiction to opiates when
used for treating pain is minuscule, less than 1 percent," Gordon said
Tuesday. "Addiction is a really complicated thing."

Cocaine, she said, is addictive; but opiates used for pain control "do not
by their chemical makeup create addiction."

And, Gordon said, traditional medical schools have not spent enough time
teaching pain control.

"There's a lot of unrelieved suffering in the world. There are so many
fears and barriers."

Gordon said recent research shows that pain itself has negative
consequences. "The science of pain is still pretty new," she said. "But we
now know that if you can treat pain pre-emptively and keep better control
of it ... those people do better."

Gordon said University Hospital was one of the earliest test sites for some
of the techniques recommended by the American Pain Society.

"We've provided a model for how you actually make these recommendations
come alive," Gordon said.