NEW YORK--Health-care professionals treating pain are hindered
by the lack of an objective way to measure pain, says Johns Hopkins
researcher Fannie Gaston-Johansson, DrMedSc, who has introduced
a new device that may help the situation (see figure).
Because pain is subjective, the patient self-report is the principal
means by which pain is assessed. But those who prescribe and administer
pain 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 American
Medical Association and Ortho-McNeil Pharmaceutical Corp., Dr.
Gaston-Johansson cited several research studies showing that certain
biases and misconceptions lead nurses and physicians to infer
less pain than patients say they experience. Among these are patient
age, gender, differences in the cultural background of caregiver
and patient, and patient behavior, said Dr. Gaston-Johansson,
associate professor, Graduate Academic Program, Johns Hopkins
University School of Nursing.
For example, children and older patients are thought to experience
less pain and so are often undermedicated. Women tend to receive
less medication than men. Patients whose cultural background is
similar to that of the caregiver receive more medication than
patients whose background is different. And patients experiencing
intense pain but exhibiting a relatively cheerful or positive
demeanor receive less medication than patients who experience
only 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 have
an ethical obligation to adequately assess and manage pain in
order to relieve patients' suffering. Furthermore, unrelieved
pain due to un-dermedication leads to increased costs, longer
hospital stays, respiratory complications, anxiety, and depression."
[See related story on the cost of undertreated pain ]
Dr. Gaston-Johansson stressed the importance of the routine use
of simple and reliable assessment tools to monitor patient pain.
She demonstrated a device she developed and has tested over the
past 10 years in Sweden and the United States. Called the Gaston-Johansson
Pain-O-Meter, this handheld scale provides patients with words
to describe their pain in two areas--sensory and emotional--and
to locate the pain and indicate its duration .