Posted August 22, 2016

Comfort and Pain: Perspectives in the Era of the Opioid Epidemic

By Dan Smith, M.D., FACEP

Modern medicine faces many challenges. Effectively managing pain in the Era of the Opioid Epidemic is one of the current challenges. The good news is, as healthcare providers, we remain dedicated to delivering safe, high quality and compassionate care. That commitment will remain no matter what the focus or epidemic.

Patterns of opioid prescribing and prevalence of misuse have created awareness of an opioid epidemic. Processes and policies are being developed and deployed which aim to mitigate opioid issues and create a safe care model that involves pain management and prescribing.

Based on significant input from many healthcare specialty groups and national organizations, Centers for Medicare and Medicaid Services (CMS) issued a statement citing that the Pain Composite of several standardized patient experience survey instruments would be "unlinked" from reimbursement calculations that have been used with these CAHPS surveys under an incentive system called Value-Based Purchasing. This move hopes to remove any pressure that might influence a provider's pain management practice in order to improve scores on a survey. Interestingly, some studies have shown lack of association between analgesic use and patient satisfaction ratings.

Although one can certainly applaud any efforts that lead to prudent and safe practices, we must be careful to not fall into a trap of "comfort and pain don't matter". Many legitimate presentations exist in inpatient, ED, outpatient ambulatory surgery and clinic settings that involve "real" pain and discomfort. Part of prudent and compassionate care in these settings would necessarily involve measures to reduce pain or discomfort, some of which may not involve medications. Regard for their pain and comfort needs is the right thing to do.

To abandon focus and best practices in this dimension of care due to a methodologic change in Value-Based Purchasing would be undermining of sound, balanced and compassionate care. We must keep in mind the intent and "why" for the recent changes yet not detract from pain management and comfort care for the legitimate patients whose conditions (post-operative care, trauma, acute exacerbations of painful conditions) warrant both assessment and treatment of it.

Additional Resources:

Below are just some of the complimentary resources and tools that offer thoughts and leading practices, many authored by practicing physicians who are treating patients daily.

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