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Eliminating Routine Inpatient Pain Assessment Won’t Solve the Opioid Abuse Crisis

The problem of prescription drug abuse and overdose — particularly opioid abuse — is at crisis level in the US and an examination of clinical practices to mitigate this crisis is necessary. 

However, a recent proposal to remove pain assessment for inpatients as the fifth vital sign in order to stem the opioid abuse crisis is not warranted, argues Marth A. Q. Curley, PhD, RN, FAAN, the Ellen and Robert Kapito Professor in Nursing Science in the Department of Family & Community Health at the University of Pennsylvania School of Nursing.

Curley and Jean C. Solodiuk, PhD, RN, manager of the pain treatment service at Boston Children’s Hospital,  defend the use of pain assessment in an editorial in the May issue of the American Journal of Nursing. Their defense stemmed from a proposal at the 2016 annual meeting of the American Medical Association, Illinois delegation, to remove pain assessment of inpatients from routine vital sign evaluation.

“While changes in clinical practice are needed, efforts to mitigate the opioid misuse crisis should instead focus on decreasing access to opioids through improved approaches to analgesic prescribing and improved risk assessment,” said Curley.

The authors agree that rethinking the current approach to pain assessment is necessary. However, they suggest that reducing opioid prescribing for conditions that may not warrant opioids, managing chronic disease with a preventive model rather than the current acute care model, improving access to mental health therapies, and reframing societal expectations are better options.

“We need a clear and consistent message regarding opioid use and systemic change based on science. We do not need to eliminate routine pain assessments to accomplish this,” said Solodiuk.