Assessment Tools Are Essential to Improve Management of Pain

NEW YORK--Health-care professionals treating pain are hinderedby the lack of an objective way to measure pain, says Johns Hopkinsresearcher Fannie Gaston-Johansson, DrMedSc, who has introduceda new device that may help the situation (see figure).

Because pain is subjective, the patient self-report is the principalmeans by which pain is assessed. But those who prescribe and administerpain medication are often influenced by other factors. The result,she said, is undermedication, often with serious consequences.

Speaking at a media briefing on pain, sponsored by the AmericanMedical Association and Ortho-McNeil Pharmaceutical Corp., Dr.Gaston-Johansson cited several research studies showing that certainbiases and misconceptions lead nurses and physicians to inferless pain than patients say they experience. Among these are patientage, gender, differences in the cultural background of caregiverand patient, and patient behavior, said Dr. Gaston-Johansson,associate professor, Graduate Academic Program, Johns HopkinsUniversity School of Nursing.

For example, children and older patients are thought to experienceless pain and so are often undermedicated. Women tend to receiveless medication than men. Patients whose cultural background issimilar to that of the caregiver receive more medication thanpatients whose background is different. And patients experiencingintense pain but exhibiting a relatively cheerful or positivedemeanor receive less medication than patients who experienceonly mild to moderate pain but complain more.

"It is distressing how poorly we're doing with pain management,"Dr. Gaston-Johansson said. "Health-care professionals havean ethical obligation to adequately assess and manage pain inorder to relieve patients' suffering. Furthermore, unrelievedpain due to un-dermedication leads to increased costs, longerhospital stays, respiratory complications, anxiety, and depression."[See related story on the cost of undertreated pain ]

Dr. Gaston-Johansson stressed the importance of the routine useof simple and reliable assessment tools to monitor patient pain.She demonstrated a device she developed and has tested over thepast 10 years in Sweden and the United States. Called the Gaston-JohanssonPain-O-Meter, this handheld scale provides patients with wordsto describe their pain in two areas--sensory and emotional--andto locate the pain and indicate its duration .

Patients Rate Their Pain

By rating their pain as ranging from cramping and dull to stabbingand sharp (sensory) and nagging and annoying to killing and torturing(emotional), patients can report to their caregivers in a mannerthat facilitates the quantitative evaluation of pain.

The multidimensional features of the device provide informationon the four major characteristics of pain: intensity, quality,location, and duration. Repeated use of the device enables caregiversto chart the pain, a practice Dr. Gaston-Johansson urges as essentialif pain management is to be improved.

"In the future, use of pain assessment tools will be partof the standard treatment. Patients will be able to evaluate theirown pain and to participate in pain management. And caregiverswill have a simple yet effective instrument for providing a validmultidimensional indication of pain," she said.