Resolution 302: Numerical Recording of Subjective Pain

Whereas, The administration of medication for legitimate pain control should not be withheld, nor should the physician or patient be viewed under suspicion of law for administering, prescribing, or receiving necessary medication; and

Whereas, Pain is a subjective and highly variable physical and psychological event; and

Whereas, Some individuals intentionally or unconsciously magnify pain descriptions to obtain narcotics; and

Whereas, A very high level of described pain is in and of itself not life-threatening but may be a symptom of an underlying life-threatening issue; and

Whereas, A very high level of described pain may be entirely independent of any life-threatening condition; therefore be it

RESOLVED, That the Texas Medical Association reject the subjective description of pain as being a "vital sign," and consider vital signs to be pulse, blood pressure, respiratory rate, and temperature; and be it further

RESOLVED, That TMA urge that the numerical recording of subjective pain not be used by any reviewing entity as a measurement of quality of any health care facility, whether that be a physician's office, outpatient surgery center, hospital, nursing home, or home nursing service; and be it further

RESOLVED, That TMA forward this resolution to the American Medical Association House of Delegates for adoption.

Relevant AMA Policy

H-120.960 Protection for Physicians Who Prescribe Pain Medication . Our AMA supports the following: (1) the position that physicians who appropriately prescribe and/or administer controlled substances to relieve intractable pain should not be subject to the burdens of excessive regulatory scrutiny, inappropriate disciplinary action, or criminal prosecution. It is the policy of the AMA that state medical societies and boards of medicine develop or adopt mutually acceptable guidelines protecting physicians who appropriately prescribe and/or administer controlled substances to relieve intractable pain before seeking the implementation of legislation to provide that protection; (2) education of medical students and physicians to recognize addictive disorders in patients, minimize diversion of opioid preparations, and appropriately treat or refer patients with such disorders; and (3) the prevention and treatment of pain disorders through aggressive and appropriate means, including the continued education of doctors in the use of opioid preparations. Our AMA opposes harassment of physicians by agents of the Drug Enforcement Administration in response to the appropriate prescribing of controlled substances for pain management. (BOT Rep. 1, I-97; Reaffirm: Res. 237, A-99; Appended: Res. 506, A-01; Appended: Sub. Res. 213, A-03)

D-120.997 Opposition of Government Determination of Appropriate Medical Practice . Our AMA will: (1) continue to support the Pain Relief Promotion Act of 1999 and will work with interested state and national specialty societies to improve the bill's language, as necessary; and (2) work with interested state and national specialty societies to improve Titles I and II of the Pain Relief Promotion Act of 1999 by deletion of those provisions which establish federal protocols and/or regulations for pain management and palliative care (including the proposed amendment to Section 502a of the Controlled Substances Act regarding educational and training programs for local, state, and federal personnel; Section 201(a)(2) of the proposed Act regarding the collection and dissemination of protocols and evidence-based practices for palliative care; and any other such objectional provisions of the proposed Act. (Sub. Res. 215, I-99)

D-220.987 Pain Management Standards and Performance Measures . (1) Our AMA shall continue to work with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and encourage continued collaborative efforts between the JCAHO and relevant medical specialty organizations to clarify the JCAHO pain management standards and to identify and clarify sources of information that are contributing to misinterpretation of the standards. (2) Our AMA, with or without partnership with other Joint Commission on Accreditation of Healthcare Organizations (JCAHO) corporate members, shall appoint a committee or task force of regularly practicing health care professionals, including a multi-specialty panel of physicians, nurses and other mid-level practitioners, and administrators to objectively study and evaluate the efficacy to date of the new JCAHO Standard as it is currently being applied and identify who is responsible for its origins. This task force shall be urged to report back to the AMA Board of Trustees at an early date so that the Board can formulate recommendations to the Joint Commission. (3) The JCAHO should be encouraged to disseminate substantial additional clarification for the "examples of implementation" and eliminate them from the accreditation manuals and other publications. (CSA Rep. 4, A-02)

TMA House of Delegates: TexMed 2006