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 .
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
