The neglect demonstrated by nurses in "Deceptive Placebo Administration" (Pain Control, August) fills me with shame. Many nursing texts discuss pain management (several dedicating chapters to the subject), yet the providers described show no evidence of this knowledge.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires facilities to develop policies and procedures to document the assessment and management of pain. Additionally, a movement is afoot to recognize pain as the fifth vital sign. Such policies have been incorporated into the new assessment tools and patient chart forms at most of the hospitals in which my students have clinical rotations. Unfortunately, the development of better tools does not necessarily lead to better care. In one of these hospitals, I recently assisted a student in the care of an 80-year-old with a fractured arm; she had received no pain medication for 48 hours, even though she rated her pain as a 10 on a 0-to-10 scale. Similarly, a teaching colleague, accompanying students to a pediatric unit, observed an eight-year-old burn patient who hadn't been medicated for more than 18 hours.

Congress passed a provision in late 2000 declaring this the "Decade of Pain Control and Research." The American Pain Society embraced this and plans to "expose undertreatment of pain as a major public health problem by educating professionals, policymakers, and consumers."1

All providers are expected to comply with pain regulations, but legislation alone may not lead to change. Extensive education, time, effort, and perhaps a total reframing of the practice of pain management will also need to take place.

Glenda Bell, MS, RN

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