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AUSTRALIAN AND NEW ZEALAND COLLEGE OF ANAESTHETISTS
ABN 82 055 042 852

FACULTY OF PAIN MEDICINE

STATEMENT ON PATIENTS' RIGHTS TO PAIN MANAGEMENT AND
ASSOCIATED RESPONSIBILITIES - 2010

1. INTRODUCTION

Since the time of Hippocrates, the treatment of pain has been an important priority of the physician. As knowledge of disease processes has advanced, the emphasis in medicine moved to diagnosis and treatment of the underlying causes of pain. However there has been a renewed focus on the management of pain itself, arising out of the complex nature of the experience of pain, humanitarian aspects, and better methods and tools for symptom control. Enhanced pain management has been associated with improved outcomes after surgery and trauma, more successful rehabilitation in patients with persistent pain and potentially improved survival of patients with cancer pain. Standards and practice guidelines have been developed for the management of all forms of pain [1-4]. Effective pain management requires assessment of physical, psychological, social and environmental factors in each patient, to facilitate strategies to improve physical, mental and emotional functioning, and to improve quality of life as rapidly and completely as possible given each individual's circumstances.

ANZCA recognises that unrelieved pain can have severe adverse physical and psychological effects on patients, with emotional, social and spiritual consequences causing suffering in patients, their families and those close to them [2]. At times severe pain can be difficult to treat and management must be subject to the availability in each health care setting of appropriate, safe and effective methods.

2. RIGHTS

ANZCA recognises that patients with pain, whether it is acute pain, pain related to cancer or persistent non-cancer pain, have the following rights:

2.1 To have their complaint of pain respected and taken seriously, recognising that pain is a personal experience and that individuals vary greatly in their responses to painful predicaments [1].

2.2 To be cared for in a timely manner by health professionals who have training and experience in assessment and management of pain, and who maintain such competencies through professional development consistent with their discipline. Where such competencies are unavailable, patients should have access to appropriate referral.

2.3 To participate actively, or have their families, carers or guardians participate, in education regarding pain and in the development of realistic goals for their pain management plan.

2.4 To expect that their "pain history", current assessment and management plan and responses to therapies will be recorded regularly and in a way that promotes optimal and ongoing pain relief.

2.5 To have access to best practice care, including appropriate assessment and effective pain management strategies, and access to suitably qualified interdisciplinary pain management teams or individuals who should be able to address physical and psychological aspects of management. These must be supported by appropriate policies and procedures.

2.6 To be informed of the evidence for the efficiency of a pain treatment, of the likelihood and duration of a successful outcome of an intervention, of other possible consequences and of alternative treatments.

2.7 To have appropriate planning for pain management after discharge from immediate care.

3. RESPONSIBILITIES

In addition, ANZCA recognises that patients or their carers and families have responsibilities that include:

3.1 To engage openly with their health care providers;

3.2 To become informed about pain and its management;

3.3 To participate actively in their own care and in decisions about their care;

3.4 To consider best-practice advice;

3.5 To advocate for better pain management.

4. FOOTNOTES

4.1 Use the words "rights" and "appropriate"

A "right to pain relief" does not imply that all pain can or will be treated successfully, that all patients will be free from pain, or that any analgesic treatment will necessarily be provided on demand, including the prescription of opioids [3.5]. "That right requires that the professional response be reasonable and proportionate to the level and character of the pain experience and that the assessment and management of a patient's pain be appropriate to that patient"[3].

4.2 International Association for the Study of Pain (IASP) Definition Pain

"An unpleasant sensory and emotional experience, associated with actual or potential tissue damage, or described in terms of such damage"[1].

4.3 Particular Patient Groups

The rights outlined above apply to all patients, including neonates, preverbal children and patients with cognitive impairment, whether due to development delay, dementia or other causes. These patients have a right to age-appropriate, development-appropriate and other suitable pain assessment tools and management [7]. In such cases, a parent, carer or other guardian must be recognised as the agent for the rights and responsibilities of the patient.

REFERENCES

1. IASP Task Force on Taxonomy Classification of Chronic Pain. 2^nd Edition IASP Press, Seattle 1994.

2. ANZCA and FPM, Acute Pain Management: Scientific Evidence. 2^ndedition, ANZCA 2005.

3. Brennan F, Cousins MJ. Pain Relief as a human right? IASP Pain Clinical Updates, XII, 4 September 2004.

4. Joint Commission on Accreditation of Healthcare Organizations. USA 1999.

5. Rich BA. Ethics of opioid analgesia for chronic non-malignant pain. IASP Pain Clinical Updates, XV, 9 December 2007.

6. In NZ there is a related document “The Code of Health and Disability Services – Consumers’ Rights".

7. Pain in Residential Aged Care Facilities: Management Strategies. Australian Pain Society, 2005, available at www.aspsoc.org.au

COLLEGE PROFESSIONAL DOCUMENTS

College Professional Documents are progressively being coded as follows:

TE Training and Educational

EX Examinations

PS Professional Standards

T Technical

POLICY – defined as ‘a course of action adopted and pursued by the College’. These are matters coming within the authority and control of the College.

RECOMMENDATIONS – defined as ‘advisable courses of action’.

GUIDELINES – defined as ‘a document offering advice’. These may be clinical (in which case they will eventually be evidence-based), or non-clinical.

STATEMENTS – defined as ‘a communication setting out information’.

This document has been prepared having regard to general circumstances, and it is the responsibility of the practitioner to have express regard to the particular circumstances of each case, and the application of this document in each case.

Professional documents are reviewed from time to time, and it is the responsibility of the practitioner to ensure that the practitioner has obtained the current version. Professional documents have been prepared having regard to the information available at the time of their preparation, and the practitioner should therefore have regard to any information, research or material which may have been published or become available subsequently.

Whilst the College endeavours to ensure that professional documents are as current as possible at the time of their preparation, it takes no responsibility for matters arising from changed circumstances or information or material which may have become available subsequently.

Promulgated: 2001

Date of current document: Oct 2008

Republished: Feb 2010

ANZCA Website: http://www.anzca.edu.au

FPM Website: http://www.anzca.edu.au/fpm

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