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From the Issue Editor: Pain Over and Over Again

More than 120 million Americans are affected by pain. It is the most common reason for seeking medical help in the United States. An estimated $100 billion is spent each year in health care costs and productivity loss. About 21.6 million Americans are taking analgesics at any one time (Meeks, 2000). About 15 to 20 years ago, pain was the buzzword in hospice. Controlling acute and chronic pain was seen as the goal of palliative care. Researchers on cancer pain developed new technologies. Hospice practitioners became pain experts. Pain relief became a right for those with less than 6 months to live, but not for anyone else. Recently, the American Medical Association and the Joint Commission on Accreditation of Healthcare Organizations recognized pain relief as a right for all people. The World Health Organization and the U.S. government set basic standards for pain relief. New regulations demand organizational and individual practitioner approaches to pain. The philosophy is that the technology is now available to prevent or reduce pain and should be used. Nurses are the most populous caregivers and are recognized by the World Health Organization as holding a primary role in pain reduction. Nurses assess and treat pain but also educate, lead, and support family members. I recently watched nurses care for children in a post–cardiac surgery setting. Some used vital sign changes as indications of pain, but others did not. A stiff, unmoving child said his pain level was 0 while his respirations dropped and his blood pressure and pulse were elevated. One nurse gave the least pain medicine possible, whereas another gave the most. The child rested short to long periods depending on the amount of medication received. He never suffered from respiratory depression, which is said by nurses to be their greatest fear in pain treatment. In this journal, many articles on pain stress the importance of assessment skills, but the issue is greater than assessment. Caregivers’ personal philosophies greatly affect the interventions provided. If caregivers value stoicism, the approach may limit the amount of drugs given. If they are authoritarian in caregiving, a decision not to give medication can occur even if patients express pain. So many different cultural issues are involved in the pain issue. So far, most of the research has focused on patients, but future studies should address the cultural issues involved in giving as needed medications. A family nursing approach to pain treatment is recommended by the World Health Organization (1999). Families are affected whenever one person suffers pain. Divorce is often a result of chronic pain in some families, whereas others place sufferers within care facilities. Some patients vote for suicide and all its familial consequences rather than continue suffering. Adequate pain interventions could solve these problems. The International Society of Nurses in Cancer Care recognized a need for internationally recognized standards of care for the dying, improved end-of-life education, increased nursing research, and prioritizing the relief of pain in end-of-life care. Nurses can only work effectively if organizations work effectively to reduce pain, so the Joint Commission on Accreditation of Healthcare Organizations set standards for organizations to care effectively for patients. Pain assessment of children and older people remain underresearched, underassessed, and undertreated. The results of pain are difficult to measure because the