Speaking of pain: Better Communication for Better Outcomes

For most patients who experience chronic pain, achieving effective pain management requires ongoing communication with their physician, said the American Pain Society (APS). Accordingly, the APS strongly supports the Joint Commission on Accreditation of Healthcare Organizations' new patient outreach and education program, Speak Out, which teaches patients to engage in productive dialogue with their physician about pain. 

Untreated and undertreated pain is a major public health concern in the United States, the APS noted. One reason why many patients do not receive effective relief is that they do not communicate effectively with their physician about their pain. They may not communicate about pain at all.

However, while patients are encouraged to be more assertive in talking about pain, physicians are encouraged to become good listeners and seek honest, frank discussion with patients about their persistent pain conditions.They should gauge the patient's pain intensity and learn how the pain influences the patient's overall quality of life.They should appreciate that pain is a multifaceted condition and that effective pain management treats not just the pain but the whole person.

Physicians may find it difficult to be effective pain managers if patients feel stigmatized or intimidated and will not talk freely about their pain, the APS suggested, noting that the new communication program can help patients overcome fear and stigma and seek help from their physician. As physicians encourage patients to feel uninhibited about discussing pain and possible treatments, however, they also must be diligent in communicating the benefits and risks of pain medications. In addition, they should monitor patients carefully once a treatment regimen has been established to determine when doses can be lowered over time as they improve the patient's pain control and overall functioning.

The APS pointed out that persistent pain may impair patients' sleep, depress their mood, and damage their self-esteem. Therefore, physicians should learn whether the pain limits the patient's everyday activities and other pursuits and strive to provide treatments that offer pain relief and help restore function and the ability and motivation to lead an active, fulfilling life. Primary care physicians should consult with pain management specialists in their communities for help in treating patients who have complex pain problems.

The APS has developed and disseminated a series of evidence-based clinical practice guidelines on the management of complex pain problems to be used by patients, payers, and providers. The guidelines address the management of several rheumatologic conditions that involve pain, including fibromyalgia syndrome, osteoarthritis, rheumatoid arthritis, and juvenile chronic arthritis. Other guidelines cover the diagnosis and management of low back pain with a variety of recommendations.

For more information on APS efforts in pain management, visit the organization's Web site at www.ampainsoc.org. Or, contact the APS at American Pain Society, 4700 W Lake Ave, Glenview, IL 60025; telephone: 847-375-4715; fax: 866-574-2654 or 847-375- 6480; international fax: 732-460-7318.