Petitions ask Joint Commission and CMS to change pain management policies

More than 60 medical experts and nonprofit organizations signed petitions last week, asking The Joint Commission and CMS for changes in their respective pain management policies. The two petitions, spearheaded by Physicians for Responsible Opioid Prescribing (PROP), claim that making physicians routinely ask about patient pain levels encourages excessive prescriptions of opioids. PROP also claims that increased opioid prescriptions are linked to rises in opioid addiction and overdose deaths. 

 “Pain is also not a single entity that warrants a formulaic ‘titrate to effect’ approach in response to a patient’s reported pain score,” PROP wrote to The Joint Commission. “Mandating routine pain assessments for all patients in all settings is unwarranted and can lead to overtreatment and overuse of opioid analgesics. Healthcare professionals are capable of using their clinical judgment to determine when to assess patients for pain.”

PROP specifically asked that The Joint Commission reexamine its pain management standards PC.01.02.07, PC.01.02.01, and RI.01.01.01. They say that since the pain management standards came into effect in 2001, over 200,000 Americans have died by overdosing on prescription opioids.

“The Pain Management Standards foster dangerous pain control practices, the endpoint of which is often the inappropriate provision of opioids with disastrous adverse consequences for individuals, families and communities,” PROP writes. “To help stem the opioid addiction epidemic, we request that [The Joint Commission] reexamine these standards immediately.”

In their letter to CMS, PROP specifically asked for three questions be removed from the HCAHPS survey:

1. “During this hospital stay, did you need medicine for pain?”
 2. “During this hospital stay, how often was your pain well controlled?”
 3. “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?”

PROP claims the financial incentives of a good HCAHPS survey encourages physicians to prescribe more opioids than they would otherwise.

“Patients suffering from pain require compassionate, evidence-based care,” PROP wrote to CMS, “Medication is not the only way to manage pain and should not be over-emphasized. Setting unrealistic expectations for pain relief can lead to dissatisfaction with care even when best efforts have been made to resolve pain. Aggressive management of pain should not be equated with quality healthcare as it can result in unhelpful and unsafe treatment, the end point of which is often the inappropriate provision of opioids.”

The petitions were signed by the heads of the National Center on Addiction and Substance Abuse, the National Women's Health Network, the American Society of Addiction Medicine, and health commissioners from Vermont, Pennsylvania, Alaska, and Rhode Island.