7 things to know about the history of The Joint Commission pain standards

The Joint Commission introduced standards for healthcare organizations regarding the treatment and assessment of pain in 2000. The standards were designed to address the lack of adequate pain treatment across the country.

While the standards were initially considered successful, adverse events stemming from the overaggressive treatment of pain quickly garnered the attention of the medical community. Now, as the nation works to restrict the proliferation of opioid painkillers to reduce the surging rates of overdoses, some experts worry the pendulum may swing back too far and result in substandard care for pain patients, according to a new viewpoint article published in JAMA.

Here are seven things to know about the history of The Joint Commission's pain standards.

1. In 1990, Mitchell Max, MD, a prominent pain specialist, penned an opinion piece in the Annals of Internal Medicine calling for a different approach to the treatment and assessment of pain. Dr. Max's approach included giving clinicians bedside tools to guide use of analgesics; enabling patients to communicate their symptoms and drive treatment; assessing patient satisfaction; and working with narcotics control authorities to foster use of opioid treatments.

2. In 2000, The Joint Commission's standards for pain management called for organizations to quantify patient pain on a 10-point scale as self-reported by the patients.

3. Pain management specialists backed the new standards upon release in 2000. The application of these standards contributed to the subsequent rise in the treatment of pain with opioid pain medication, according to JAMA.

4. While a 2003 survey of more than 200 pain patients highlighted a 90 percent satisfaction rate for the pain medications, many clinicians began raising concerns about relying to heavily on opioid medications for pain management around the same time period, according to the JAMA article.

5. As concerns and adverse events associated with opioids continued to mount, the commission began altering its pain standards. By 2004, the designation of pain as the fifth vital sign issued in 2001 was stripped from the commission's accreditation standards manual.

6. In January of this year, The Joint Commission issued new pain management standards for public comment. The standards' provisions include the monitoring of opioid prescriptions, a focus on the assessment of how pain impairs physical function and the promotion of nonpharmacologic pain treatments, among other recommendations.

7. In an assessment of this history, the authors of the JAMA viewpoint concluded, "Concerns about unintended consequences should not serve as a deterrent from pursuing 'noble' goals. The original pain standards of The Joint Commission were a bold attempt to address widespread underassessment and undertreatment of pain. As The Joint Commission and other organizations across the country work to address the prescription opioid problem, it will be important to proceed not only with these lessons in mind but also with the confidence that effectively counteracting the opioid epidemic represents a necessary and worthy goal."

More articles on opioids: 
Study: Chronic pain, mental health patients prefer medical marijuana to prescription drugs 
Massachusetts governor cuts $150,000 in opioid abuse funds for Lynn 
Large number of patients on anti-addiction medication may also have opioid prescription

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