VA SEES PAIN IN A NEW LIGHT -- ILLNESS

Agency hopes to cut suffering by helping patients cope with
it

WASHINGTON - In a first for the huge health provider, the Department
of Veterans Affairs next month will launch a systemwide effort to
reduce pain and suffering for many of its 3.4 million patients.

All VA doctors and nurses will be instructed to treat pain as a "fifth
vital sign," which means they are supposed to assess and record
patients' pain just as they would note other health care basics Re
blood pressure, pulse, temperature and breathing rate.

The doctors and nurses. are to ask patients to rate the pain on a
scale of 1 to 10. They the would consult with patients about ways to
deal with it.

"It's really changing how people think," said Dr. Kenneth Kizer, the
VA's undersecretary for health. "We're too often obsessed with the
diagnosis and finding what's going on in a molecular, cellular,
pharmacological level as opposed to, is the person feeling better?"

It might take two or three years to implement the program at all
1,100-sites where the VA delivers health care, he said.

Arthur Zeeck 44, of Tacoma, had to quit his job as an aircraft
mechanic in 1994 because of pain from Crohn's disease, a
stress-related gastrointestinal disorder. He was dissatisfied with his
pain treatment at a local civilian hospital.

"They weren't taking the pain I was having very seriously," he said.
"They thought I was just trying to get drugs."

But after finding his way to the pain clinic at the Seattle VA
hospital - and after a year and a half of outpatient visits there - he
is ready to begin a new career as a home inspector.

"In the pain clinic, they make you realize that zero pain is something
that you're probably never going to achieve," Zeeck said. "They
control the pain medication here. Before, they were giving me pain
medication every time I said ouch."

Officials at the Seattle VA say they combine physical medicines with
mental-health disciplines and occupational therapy.

"Pain has been treated as a symptom for so long, and it's really a
condition that needs treatment," psychologist Mark Hawley said.

The initiative, which evolved from agency efforts to improve
end-of-life care, also calls for staff training in pain treatment and
spending $3 million to $5 million on pain-management research.

That such a large medical system - the nation's biggest - is
heightening efforts to fight pain is laudable, health and pain experts
said.

It really is a significant step forward," said Richard Muir, executive
director of the American Pain Society, a professional society of
nearly 4,000 clinicians and academics based in suburban Chicago and
founded in 1978. "There are not many large organizations that have put
together a systematic approach to pain management."

Dr. Thomas Reardon, a Portland, Ore., doctor and president elect of
the American Medical Association, said, "There's a new awareness out
there among the health care industry that we need to do a better job"
on pain.

The VA effort is "another circumstance where a hospital system ... is

aware that we need to make improvements and is talking steps to
improve," Reardon said.

The effort to make pain treatment a higher priority in medicine is not
new. Experts have been talking of the need to improve pain treatment
at least since the 1970s, and the American Pain Society has urged
treatment of pain as a 'fifth vital sign' since 1995.

Many hospitals have established pain centers and pain-treatment
programs.

Many others, however, are doing little or nothing on the pain front,
experts say.

"It's spotty, and some years ago, it was universally just terrible,"
said C. Richard Chapman, an anesthesiology professor at the University
of Washington and president-elect of the Society.

Studies and experts estimate that tens of millions of Americans suffer
from some sort of pain each year, with persistent pain costing around
$100 billion a year in lost productivity. A study published " June's
Journal of the American Medical Association found that one of four
'elderly cancer patients in nursing homes received nothing for their
daily pain.

Part of the blame lies with patients, who don't want to be seen as
whining for pain treatment, said Barbara Coombs Lee, executive
director of Compassion In Dying in Portland, Ore.

"Patients are sensitive to be labeled as drug seekers," she said.
"They don't want to appear as being weak.'

And some doctors worry they will draw the attention of authorities if
they prescribe too many painkillers, experts say. Many doctors were
taught to be wary of giving large doses of drugs have concerns about
addiction.

"The general message that was given was that one had to be very
cautious,' said Dr. Michael @tcomb, senior vice president for medical
education at the Association of American Medical Colleges.