Pain Management in Special Populations

Overview
Recent medical studies reveal disturbing inadequacies in pain assessment and treatment strategies. Consider the following examples:

• A random sample study of 454 medical-surgical inpatients found that 79% of them experienced pain while hospitalized, and 58% of these patients reported pain that was horrible or excruciating
• A study of seriously ill hospitalized patients determined that of the 50% complaining of pain, one sixth experienced extremely severe pain at least half the time²

The sheer magnitude of pain management research is staggering, and conclusions are generally consistent: a significant percentage of patients are needlessly suffering from pain. Why? The reasons are varied and complex.

Physician reluctance to treat pain aggressively because of regulatory scrutiny and addiction concerns is pervasive and well documented. Studies also point to lack of knowledge and training, myth belief systems, and ethnic/ racial / age/gender biases as barriers to effective pain relief practices. Special patient populations - the elderly, children, women and minorities, and individuals with comorbidities - are appreciably at greater risk of pain because of these factors.

As expectations and priorities rise to provide optimal pain relief, physicians will be held increasingly accountable for their attitudes and actions in the pain control arena. To effectively manage risk, health care providers are urged to examine and correct any deficits in current pain management practices.

This monograph broadly addresses the legal aspects of pain management, and specifically highlights treatment barriers, disparities and challenges in special patient populations.

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