Have you ever felt as if your doctor wasn’t really listening to you or was just rushing through your appointment? Have you ever felt as if your doctor didn’t understand the pain you were in or didn’t take it seriously? Most health care providers are evaluated based on the experience their patients had, and their payment is often based on those patient experience scores. A major component of patient experience measurement is pain, an element no longer measured. In a classic 2012 study, over 126 million adults reported experiencing pain in the last three months. Today, disparities in pain management are observed by race/ethnicity and gender. A 2021 study of nearly 500,000 hospitalized patients in Taiwan found, “Pain is the most common symptom of patients, the most common reason for patients to seek medical treatment, and the most common problem that needs to be dealt with.” Indeed, pain is a constant in so many people’s lives that a popular app, Manage My Pain, is the source of research on communication with health care providers. Some argue that evaluating doctors based on whether they adequately treat pain promotes over-prescribing of opioids. Yes, over-prescribing of opioids was and still is a major problem, and those to blame are being held accountable, as seen in the recent $650 million ruling that CVS, Walgreens, and Walmart were ordered to pay for flooding two Ohio counties with pills. But expecting a doctor to acknowledge a patient’s pain, listen, take their pain seriously, and do everything possible to help manage pain, are not the same as expecting a doctor to prescribe an opioid. There is a world of pain management outside of opioids, including non-steroidal anti-inflammatory drugs, acupuncture, massage, cold therapy, and heat therapy. Ignoring those options at the cost of leaving patients in pain is unacceptable. I worked as a statistician at the RAND Corporation for ten years and, in that role, led the $9.4 million project funded by the Centers for Medicare & Medicaid Services (CMS) to develop a national patient experience survey for the emergency department setting. My project team did extensive research and testing on measuring pain: how to ask patients about their pain and specific question-wording. Beyond the ubiquitous 1-10 pain scale, the questions went beyond asking about pain control. For example, questions included: “During this emergency room visit, did the doctors or nurses talk with you about how much pain you had?”; “Did the doctors and nurses try to help reduce your pain?” and “Did the doctors or nurses give you as much information as you wanted about how to treat your pain at home?” In the emergency department survey, pain questions such as these were on early versions of the survey fielded in 2014, 2016, and 2018 in 78 hospital-based emergency departments across the nation but are no longer included in the current version endorsed by the Agency for Healthcare Quality and Research to measure patient experience in the emergency department. CMS removed pain questions from the nationally implemented hospital inpatient survey in 2019 because they had reportedly come under incredible political pressure to remove them. As part of the U.S. Department of Health and Human Services, CMS supports a number of initiatives designed to provide access to high-quality care and improved health at lower costs, including the development and implementation of multiple patient experience surveys. This pressure reportedly came from both doctor organizations, including the American College of Emergency Physicians and the Physicians for Responsible Opioid Prescribing, and members of U.S. Congress. The argument was that having these questions on the survey incentivized doctors to inappropriately prescribe opioids. However, research from multiple sources, including a medical journal, has failed to identify a link between patients’ reporting their pain was adequately addressed and opioid prescribing. People go to the emergency department for several reasons; they may have had an accident or are suffering an acute health emergency, they may be in pain, and/or they may have no health insurance, which is the only option. To not consider the management of pain a critical part of patient care in the ED is astounding. I know this from personal experience. In January 2020, before COVID arrived in the U.S., I went to an emergency room by ambulance with severe stomach pain. I waited for an available room on a gurney in the hallway for two hours. I was sobbing and pleading loudly for help, for something for my pain. No one attended to me or asked me questions. I have never felt so alone, helpless, and discarded. Months of follow-up later revealed my pain was most likely due to pelvic congestion syndrome. Yes, the opioid crisis in this country has caused a reckoning in the medical field about how to treat patient pain. Ignoring the pain will not make it go away. Options are available beyond opioids, and policymakers and health care providers need to be aware that attention to effective health care practices must move beyond silencing to solutions. Source
