Improving Pain Management for Hospitalized Patients

Download the Improving Pain Management Guide

Pain is a major public health problem affecting more American adults than heart disease, cancer and diabetes combined. More than 116 million adults in the U.S. suffer from chronic pain, and federal expenditures for pain care total $99 billion a year. Management of pain costs up to $635 billion each year in medical treatment and lost productivity.1 The negative physiological, psychological and social consequences of pain are well documented. A number of advances have occurred in recent decades to improve the quality of pain management. Pain education is required in training and continuing education of heath care professionals. Specialties have been created in pain management and palliative care. Institutions have created comprehensive programs to provide expert pain management throughout the care continuum. The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) accreditation program includes national standards on assessment and management pain in all settings where patients are cared for.

Despite these advances, a number of gaps remain in the quality and safety of pain management provided to patients. Hospitalized patients continue to experience moderate to severe pain. Over-reliance on opioid-based therapies has led to significant adverse events and a nationwide epidemic of opioid misuse and diversion.3-6

As frontline physicians in hospitals and leaders of quality improvement programs, hospitalists find themselves in the cross-hairs of these national problems of inadequate pain treatment and opioid misuse. Though pain management is a core competency for hospitalist physicians,7 many hospitalists find themselves under-trained to safely and adequately treat pain. Furthermore many hospitals and medical centers lack robust and coordinated pain care systems that optimize both opioids stewardship and patient outcomes.

The goal of this Guide is to provide practical advice to hospitalist physicians and other leaders who are developing programs to improve pain management in their services and facilities. The focus is on medical patients, though many of the principles described here are relevant to patients recovering from surgical care who are increasingly co-managed by hospitalists. The following content on best practices in pain management are drawn from a multidisciplinary national expert panel. The quality improvement practices are drawn from our own experience as well as previous work in other fields including previous Society of Hospital Medicine Implementation Guides. We applaud your work to improve pain management for your patients and hope this Guide will be of use in your efforts.

About the Project Team

  1. Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press; 2011.
  2. Gupta A, Daigle S, Mojica J, Hurley RW. Patient perception of pain care in hospitals in the United States. J Pain Res. 2009;2:157-164.
  3. Herzig SJ, Rothberg MB, Cheung M, Ngo LH, Marcantonio ER. Opioid utilization and opioid-related adverse events in nonsurgical patients in US hospitals. J Hosp Med. Feb 2014;9(2):73-81.
  4. Bohnert AS, Valenstein M, Bair MJ, et al. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. Apr 6 2011;305(13):1315-1321.
  5. Manchikanti L, Helm S, 2nd, Fellows B, et al. Opioid epidemic in the United States. Pain Physician. Jul 2012;15(3 Suppl):ES9-38.
  6. Manchikanti L, Abdi S, Atluri S, et al. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I--evidence assessment. Pain Physician. Jul 2012;15(3 Suppl):S1-65.
  7. The Core Competencies in Hospital Medicine. Society of Hospital Medicine; 2008. http://www.hospitalmedicine.org/Web/Education/Core_Competencies/Web/Education/Core_Competencies.aspx. Accessed July 2008 (updated on 2014).

Improving Pain Management for Hospitalized Patients  Implementation Toolkit Project Team
This implementation toolkit is supported in part by a medical education grant from Pfizer Pharmaceuticals.