BACKGROUND:
Pain is the number one reason people seek medical advice (Tollison, 1989). Aggressive treatment of the acute pain process reduces the risk of chronic pain development and potential disability (Brookhoff, 2000). Chronic pain prevalence in the adult population has been conservatively estimated at 57% (Peter D. Hart Research Associates, 2003). The regulatory, legislative, economic and other barriers to effective pain management must be eliminated. Personal biases should be recognized and must not be allowed to influence pain assessment and treatment.

POSITION STATEMENT
Pain Definition (OPI, 2005) - Pain is a perception driven by emotional and physiological processes, with or without identifiable pathology and relative to the environment in which it is experienced.

Patient Rights and Responsibilities*:

• All people have the right to optimal pain management.
• Healthcare consumers have the responsibility to openly and honestly communicate with their caregiver regarding their pain needs and responses to treatment.

*See "OHIO PAIN INITIATIVE PATIENT BILL OF RIGHTS AND RESPONSIBILITIES FOR PAIN RELIEF,October 2004"

Pain Assessment:

• Healthcare providers have the ethical responsibility to acquire pain information relevant to the entire patient experience and respond based on current standards of care.
• A quality, comprehensive pain assessment includes an inquiry into the patient's emotional, social, and spiritual resources and concerns.

Pain Treatment:

• Healthcare providers have the ethical responsibility to provide comprehensive pain management including consideration of pharmacological, non-pharmacological, and complementary interventions.
• Pain treatment is a collaborative effort among an interdisciplinary healthcare team, the patient, and the patient's family.

Route of administration:

• Oral route of administration is always preferred.
• When appropriate, subcutaneous route of administration is preferred over intramuscular.
• Check with qualified healthcare specialist regarding novel routes of administration.

Dosing:

• "Effective pain management requires careful individual titration of analgesics that is based on a valid and reliable assessment of pain and pain relief" (APS/ASPMN, 2004).
• Ohio Pain Initiative recognizes the APS/ASPMN position statement on "The Use of 'As Needed' Range Orders for Opioid Analgesics in the Management of Acute Pain".

Opiate therapy

• Long-acting opioids should be considered when patients have pain most of the day
• Immediate release opioids for breakthrough pain should be utilized along with long-acting opioids.
• The use of opioids for the management of chronic non-malignant pain may be appropriate as determined by a thorough pain assessment and on-going monitoring for effectiveness.
• The use of meperidine and propoxyphene is not recommended.

Pain Education:

• Placebo should not be used to diagnose, assess, or manage pain in any patient. Placebo may be utilized for the purposes of an IRB approved research study. Ohio Pain Initiative recognizes the IASP "Ethical Guidelines for Pain Research in Humans" (1995).
• The curricula of all medical, nursing, pharmacy and allied health training programs/schools should include education in pain management.
• All health care providers have an ethical responsibility to maintain continuing education in pain management.
• Providers of healthcare have an ethical responsibility to educate consumers about pain management.

Quality :

• Healthcare systems are responsible for adopting and monitoring outcomes of pain management and implementing quality improvement measures as indicated.