Joint Commission releases rebuttal to critics of pain management standards

Accreditation Insider, April 26, 2016

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The Joint Commission last week published a press release and an eight minute video defending its pain management standards. The response came five days after the accreditor received a petition begun by the Physicians for Responsible Opioid Prescribing (PROP), which claimed the pain management standards were linked to excessive opioid prescriptions. The petition asked The Joint Commission to reexamine pain management standards PC.01.02.07, PC.01.02.01, and RI.01.01.01 and was signed by over 60 medical experts and nonprofit organizations.

“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,” according to PROP’s petition.

It also said that opioid prescriptions rates and opioid addiction rates were linked, with more than 200,000 Americans dying due to prescription opioid overdoses since the pain management standards came into effect in 2001.

Joint Commission Executive Vice President David Baker, MD, MPH, FACP, said in a press release that in the midst of the opioid epidemic, people are looking for someone to blame. The accreditor encouraged critics to look at the pain management standards along with their historical context to understand what they actually require facilities to do.

“The Joint Commission first established standards for pain assessment and treatment in 2001 in response to the national outcry about the widespread problem of undertreatment of pain,” the press release said. “The Joint Commission’s current standards require that organizations establish policies regarding pain assessment and treatment and conduct educational efforts to ensure compliance. The standards DO NOT require the use of drugs to manage a patient’s pain; and when a drug is appropriate, the standards do not specify which drug should be prescribed.”

While not specifically mentioning the PROP letter, The Joint Commission’s press release refuted several claims brought up in the petition. The accreditor targeted five claims in particular: that they endorse pain as a vital sign, requires pain assessment for all patients, require pain to be treated until the pain score reaches zero, that the standards push doctors to prescribe more opioids, and that the pain standards caused a sharp rise in opioid prescriptions.

“The original 2001 Joint Commission standards did not state that pain needed to be treated like a vital sign,” Baker wrote. “The only time that the Joint Commission standards referenced the fifth vital sign was when The Joint Commission provided examples of what some organizations were doing to assess patient pain. In 2002, The Joint Commission addressed the problems in the use of the 5th vital sign concept by describing the unintended consequences of this approach to pain management and described how organizations had subsequently modified their processes.”

You can view The Joint Commission’s video here, as well as read the Physicians for Responsible Opioid Prescribing letter to The Joint Commission.

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