Document Type


Publication Date

September 2001


This article was published in Disease Management, September 2001, Vol. 4, No. 3: 85-102. ( Deposited by permission; copyright retained by Mary Ann Liebert, Inc.


Although medicine possesses the knowledge and technology for preventing or relieving most pain, poor pain control is still widespread. Unrelieved pain causes unnecessary suffering and increases health care expenditures. Among the barriers to improving pain control are poor provider education in pain management, misguided beliefs about the inevitability of pain and the dangers of pain medication, provider resistance to changing practice patterns, and administrative resistance to implementing improvements that incur short-term costs but lead to long-term savings. In short, poor pain relief in America's health care institutions is a system issue, and improvement requires a system-wide change. An effective program for improving pain management requires a multidisciplinary team committed to the task, ideally a triad consisting of a physician, a nurse, and a pharmacist. The triad needs administrative support in order to undertake needs assessment, offer provider and patient education, and perform continuous cycles of assessment, intervention, and reassessment of pain management. A strong information management base and an analytic engine are essential so that the team can evaluate outcomes from multiple perspectives (provider, payer, patient). The triad should identify a service area with clear pain problems, demonstrate improvements in this area, and then systematically move to other service areas. Educating providers and patients about pain and its control is essential for bringing about change. Improved pain management is a win-win situation for patients and institutions alike. Patients and families benefit from reduced suffering and improved quality of life, while institutions can offer more cost-effective care to patients.



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