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Relief of pain is one of the great objectives of medicine. Pain
is the most common symptom reported to physicians; more than 80% of
all patients who see physicians do so because of pain. It has been
a predominant concern of humankind since the beginning of recorded
history. Chronic pain affects hundreds of millions of people worldwide,
altering their physical and emotional functioning, decreasing their
quality of life, and impairing the ability to work. It affects general
health, psychological health, and social and economic well-being.
Patients in chronic pain use health services up to five times more
frequently than the rest of the population. The cost of unrelieved chronic
pain in the United States is more than $50 billion per
year (more than $80 billion per year if lost wages from
work are counted) and in the age of steady cost-cutting in a managed
care environment, we can no longer afford it. More than 550 million
workdays are lost every year because of chronic pain. Yet 40% of
all cancer patients, 50% of nursing home patients, 55% of
postoperative patients, and 70% of patients with acquired
immunodeficiency syndrome (AIDS) have unrelieved or inadequately
relieved pain.
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In October 2000, the 106th U.S. Congress passed HR 3244, which
was then signed into law. Title VI, Sec. 1603, provides for the “Decade
of Pain Control and Research,” to begin January 2001. It follows
the “Decade of the Brain” and is only the second
congressionally declared, medically related decade. Pain is now
designated as a public health problem of national significance.
Beginning in 2001, the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) implemented new standards to assess and treat
pain. To qualify for accreditation, all facilities, including rehabilitation
centers, outpatient surgical centers, hospitals, and nursing homes,
must recognize the right of patients to appropriate assessment and
management of pain. All health care facilities must identify pain
in patients during initial assessment and, where required, during ongoing
periodic assessments and must educate patients and their families
about pain management.
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The word pain is derived from the Latin poena, meaning punishment.
The International Association for the Study of Pain (IASP) defines
pain as “an unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or described
in terms of such damage.”1 This definition
may appear somewhat convoluted, but it clearly states that pain
is subjective. It is both a physiologic sensation and an emotional
reaction to that sensation. Viewed from an evolutionary prospective,
pain is perceived as a threat or damage to one’s biological
integrity and has three components: sensory-discriminative, motivational-affective,
and cognitive-evaluative.
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The concepts of pain and suffering are frequently mixed and sometimes
confused in the dialogue between patient and physician, ...