VA TO TAKE A LOOK AT HOW TO TREAT PAIN -

The Assessments Could Be Used To Develop A National Treatment Policy.

WASHINGTON - How to you ease a patient's persistent, severe pain? Soon, the
federal government hopes to find an answer.

Beginning in January, the U.S. Department of Veterans Affairs will do what
few health-care providers have done. It will assess a patient's pain as it
gauges other vital signs, such as temperature, blood pressure and pulse.

Veterans facilities, ranging from hospitals to nursing homes to clinics,
will use the assessments to develop long term strategies for treating both
chronic and acute pain.

"One of the goals of this national strategy is that no dying veteran shall
suffer from preventable pain while being cared for by the VA health-care
system", said Bonnie Ryan, the VA's chief of home and community based care.

"We want to get pain assessment performed in a consistent manner. We also
want to assure (patients) that pain treatment is prompt and appropriate,"
Ryan added.

The medical overseer of the Grand Rapids Outpatient Clinic believes the new
strategy could help some veterans avoid a trip to Ann Arbor for pain
management.

"We would be addressing these issues on a comprehensive basis" said Dr.
Sita Kondapaneni, chief of physical medicine and rehabilitation for the
Battle Creek based Veterans Affairs Medical Center.

Kondapaneni said officials will asses veterans who use the Grand Rapids
clinic to see who might benefit from such an approach, which would convene
specialists in rehabilitation, anesthesiology, psychology, psychiatry to
determine the best course of pain treatment.

"We will be able to do more than we have in the past" Kondapaneni said.

Michigan medical officials believe the new VA policy will do more than help
veterans. It will also set an example for health care providers.

A change in VA policy can have that kind of impact because the system is so
large. It serves more than 25 million veterans nationally.

One-third of the nation's medical residents and about half of the medical
students are trained each year in VA facilities, VA officials say.

"The need is out there", said Robert Werner, who directs the Ann Arbor VA
Medical Center's physical medicine and rehabilitation program. "Not enough
people ... know how to manage (pain). A national strategy will not only
focus on pain clinics like ours, but will focus on educating our primary
care doctors in all our facilities."

Plus, the new VA policy may show physicians that the federal government
cares as much about easing pain as it does about stopping doctors who are
trafficking in drugs.

"The government's war on drugs has had a chilling effect on liberal
prescribing for patients who have legitimate needs," said Dr. John Finn,
medical director for the Hospice of Michigan, a non-profit group that
operates 25 hospices throughout the state.

"It's stunted physicians attitudes as well as skills in regards to pain
management. Finally the government is saying we have a problem here."

In Michigan, the VA main management strategy will be implemented in it's
five medical centers in Ann Arbor, Battle Creek, Detroit, Iron Mountain and
Saginaw.

Veterans, about 949,000 in Michigan, also will be able to receive
assistance with pain at outpatient clinics in Gaylord and Grand Rapids.

Physicians expect the assessment procedure to be difficult to implement if
only because it's so individual. It probably will be done verbally with the
patient rating his or her pain on a scale from 1 to 10.

Once assessed, doctors will need to match the treatment with a patient's
specific needs. Is it a pain related to cancer treatments? Or is it a pain
as a result of back or muscle injuries? Treatments could range from
exercise regimens to narcotics, such as morphine, to using electrical
devices to interrupt nerve impulses.

"It's not so much that this is new knowledge," Ryan said. "It's bringing
all kinds of information together in a new way to make it easy for people
to do the right thing (for patients)."

Michigan hospitals and doctors are watching. Many hope the strategy will
spur efforts in private facilities.

"We are in the infancy of pain assessment and management," said Dr. Cathy
Blight, president of the Michigan State Medical Society, a group
representing about 11,000 Michigan doctors. "Pain is very subjective. What
one person can handle ... another person can't, so that requires a very
specialized response to each individual patient."

Up to now, the medical responses have been guided, in part, by wary
physicians who feared losing their drug prescribing licenses to anti-drug
government regulators.

That wasn't helped much by Congress' attempts this year to establish a
tracking system for addictive drugs and the physicians who prescribe them.
The bill, spurred by fears that physicians might abuse Oregon's assisted-
suicide law, eventually died in committee.

Meanwhile, the state Legislature took a less aggressive step, passing bills
requiring physicians to be educated about severe pain and how to treat it.
The legislation is awaiting Gov. John Engler's signature.

"I'd like to see a statement from state lawmakers or the federal government
outlining what is good care and adequate care," said Finn. "The public's
attitudes are changing, so should the government's."

The VA's pain management strategy may be just that. It surely is the best
example of the medical community's recognition of the role it plays in end-
of-life care.

Death has always been viewed as a failure of the health care system," said
Patrick Foley, spokesman for the Michigan Health and Hospital Association,
which represents hospitals and health maintenance organizations. "There's a
realization now that death is an integral part of life. Hospitals are
taking more seriously their roles in providing dignified, end-of-life care
for all their patients."

Checked-by: Richard Lake