So he was pleasantly surprised when he woke up at Virginia Mason Medical Center after the surgery, which required incisions across his chest and abdomen, and felt no discomfort at all. Within hours Stuckrath was able to stand up and even take a few steps. Six days later he was discharged. “It was pretty miraculous,” he says. “Not having pain made all the difference.”
There’s no question that managing pain plays a central role in a patient’s recovery, but at many hospitals, it has often seemed an afterthought rather than a priority. That’s starting to change. In January 2001, the Joint Commission on Accreditation of Healthcare Organizations implemented its first pain-management guidelines, requiring the country’s more than 4,400 accredited hospitals to make sure that all patients are evaluated (using a now standard scale of zero to 10) and treated for pain.
That was a critical first step, but some hospitals, like Virginia Mason, have gone much further. A few years ago CEO Gary Kaplan adopted Toyota Motor Co.’s “lean manufacturing” model–which focuses on decreasing errors and increasing productivity and customer satisfaction–and encouraged his 5,000 staff members to submit suggestions. That led to innovations in several areas, including pain management.
Patients like Stuckrath are the beneficiaries. He got a thoracic epidural that delivered both a narcotic and a local anesthetic, a technique shown to help patients wake up faster and in less pain. A “pain-service team”–a doctor, nurse specialist, pain fellow and resident anesthesiologist–checked on him twice a day as he recovered, and a nurse came by every two hours to record his pain scores on an electronic chart and make medication adjustments. Between visits, Stuckrath could self-administer an additional dose if he became too uncomfortable. “We think you should look at the quality of life, too, not just getting through the surgery, and pain is a big part of that,” says Dr. Donald Low, surgical director of the thoracic-oncology program, who operated on Stuckrath.
Other institutions–like the Cleveland Clinic and Veterans Health Administration–have also won accolades for their pain-management practices. But experts say many hospitals are lagging. “We’re now assessing pain, but it’s still not clear that we’re adequately treating it,” says Dr. Fred Burgess, president of the American Academy of Pain Medicine.
A major obstacle is the lack of trained practitioners. An estimated 50 million Americans have chronic pain and nearly 25 million suffer acute pain from an injury or surgery each year. “We simply can’t turn out pain specialists as fast as we’d like to,” says Dr. Ken Follett, president of the American Board of Pain Medicine, which has certified about 2,020 physicians. There are fellowships, he says, but no residency programs for clinicians to specialize in pain management. Efforts to boost federal funding for training and new treatments have so far been unsuccessful.
Pain specialists are trying to fill the gap by raising awareness. “We’ve made strides,” says June Dahl, a professor of pharmacology at the University of Wisconsin, who helped write the 2001 standards. But, she adds, there’s still much more work to do before the treatment that Stuckrath got at Virginia Mason becomes standard rather than “miraculous.”
