TJC has clarified its position on pain management, and it is underscoring its belief that drugs are not always required to manage pain. The statement followed a letter sent by more than 60 non-profit groups and medical experts to TJC that asked it to revisit its pain management standards.
The letter specifically took issue with what it said were guidelines instructing doctors to routinely ask patients to assess their pain.
“The Pain Management Standards foster dangerous pain control practices, the endpoint of which is often the inappropriate provision of opioids with disastrous adverse consequences for individuals, families and communities,” the letter said. Deaths linked to misuse and abuse of prescription opioids rose to almost 19,000 in 2014, according to the CDC.
The letter effort was led by Physicians for Responsible Opioid Prescribing, which encourages alternative treatments to opioids, including non-opioid pain relievers, psychotherapy, and physical therapy. (For more information on this group, readers can access their web page at http://www.supportprop.org.)
3 Steps from Joint Commission
TJC responded with a statement that said healthcare providers should do the following:
- educate all licensed independent practitioners on assessing and managing pain (applies to hospitals);
- respect the patient’s right to pain management (applies to hospitals and ambulatory organizations);
- assess and manage the patient’s pain (applies to hospitals, ambulatory organizations, and office-based surgeons).
TJC leaders said the statement was an attempt to combat misconceptions about its recommendations. Specifically, TJC said the following:
- It does not require treatment until pain scores reach zero.
- It doesn’t push doctors to prescribe opioids.
- Its standards have not led to a dramatic increase in opioid prescriptions.
David W. Baker, MD, MPH, executive vice president of healthcare quality evaluation at the TJC, said, “In the environment of today’s prescription opioid epidemic, everyone is looking for someone to blame. Often, TJC’s pain standards take that blame. We are encouraging our critics to look at our exact standards, along with the historical context of our standards, to fully understand what our accredited organizations are required to do with regard to pain. We believe that our standards, when read thoroughly and correctly interpreted, continue to encourage organizations to establish education programs, training, policies, and procedures that improve the assessment and treatment of pain without promoting the unnecessary or inappropriate use of opioids.” (To access the statement, go to http://bit.ly/1sklA58. For more information on this topic, see "Researchers show rising opioid prescriptions following low-risk surgeries," Same-Day Surgery, May 2016, at http://bit.ly/1rgmCi6.)
ASA and AMA speak out
The American Society of Anesthesiologists (ASA) has formed a committee to address opioid abuse and encourage co-prescribing of naloxone. The Ad Hoc Committee on Prescription Opioid Abuse will focus on identifying commonsense ways to reduce prescription opioid abuse and promote safe and effective treatments for patients with chronic pain. Additionally, ASA announced the release of its statement by ASA’s Committee on Pain Medicine encouraging physicians to consider co-prescribing naloxone with an opioid for patients at high risk of overdose.
As part of ASA’s efforts to reduce the misuse and abuse of prescription opioids, ASA worked with the White House Office of National Drug Control Policy to develop a wallet-sized card describing the signs and symptoms of an overdose, as well as instructions for assisting someone suspected of an overdose, including instructions to administer naloxone and call 911. (To access the card, go to http://bit.ly/1kEtXgD.)
ASA is also working with groups on efforts that include supporting prescription drug monitoring programs, enhancing physician education on pain care, and increasing research directed at pain medicine therapies.
In other news, Steven Stack, MD, CEO of the American Medical Association, has called on physicians to limit the amount of opioids prescribed for postoperative care and acutely injured patients. In an open letter on the opioid epidemic that was published in the Huffington Post Blog, Stack urged physicians to avoid initiating opioids for new patients with chronic non-cancer pain unless the benefits outweigh the risks. He also urged physicians to register for and use their state Prescription Drug Monitoring Program, identify and help patients with opioid use disorder obtain evidence-based treatment, and co-prescribe naloxone to patients at risk for overdose. (Readers can access the letter by going to http://huff.to/1T5DxOB.)