[Congressional Record Volume 147, Number 21 (Wednesday, February 14, 2001)]
[Senate]
[Pages S1389-S1390]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                VA LEADS THE NATION IN END-OF-LIFE CARE

  Mr. ROCKEFELLER. Mr. President, the Department of Veterans Affairs 
has been quick to embrace the idea that more needs to be done to deal 
with patients' pain, and this has become an integral part of VA's 
overall efforts to

[[Page S1390]]

improve care at the end of life--for veterans and for all Americans. As 
ranking member of the Committee on Veterans' Affairs, I am enormously 
proud of VA's efforts in pain management and end-of-life care. I 
suspect, however, that many of my colleagues are unaware of VA's good 
work in this area.
  We simply must recognize the lack of services and resources for 
people who are suffering with pain, especially those who need long-term 
institutional care and other alternatives, such as hospice or home 
health for chronic conditions. The health care and related needs of 
Americans are very diverse. We must target problems and address them 
with creativity, with a variety of resources that can help different 
groups in different ways. Taking a look at the VA's success in this 
area is a good place to start fixing the problem.
  I therefore ask unanimous consent that a press release on VA's pain 
management initiatives and a Washington Post article on VA's success in 
this area be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                  VA Initiates Pain Management Program

       Pain is one of the most common reasons people consult a 
     physician, according to the American Academy of Pain Medicine 
     and the American Pain Society. In fact, it is the primary 
     symptom in more than 80 percent of all doctor visits and 
     affects more than 50 million people. In January 1999, the 
     Department of Veterans Affairs (VA) took the lead in pain 
     management by launching a nationwide effort to reduce pain 
     and suffering for the 3.4 million veterans who use VA health 
     care facilities.


                         VA and Pain Management

       VA believes that no patient should suffer preventable pain. 
     Doctors and nurses throughout VA's 1,200 sites of medical 
     care are required to treat pain as a ``fifth vital sign,'' 
     meaning they should assess and record patients' pain just as 
     they note the other four health-care basics--blood pressure, 
     pulse, temperature and breathing rate. They ask patients to 
     rate their pain on a scale of zero to 10, then consult with 
     the patients about ways to deal with it.
       ``It changed how VA approached pain,'' said Dr. Jane 
     Tollett, national coordinator of VA pain management strategy. 
     ``We're too often obsessed with finding out what's going on 
     at the molecular, cellular and pharmacological levels as 
     opposed to asking: Is the person feeling better?'' Measuring 
     pain as a vital sign was part of the first step in the 
     following comprehensive strategy to make pain management a 
     routine part of veterans' care.
       Pain Assessment and Treatment: Procedures for early 
     recognition of pain and prompt effective treatment began at 
     all VA medical facilities. Pain management protocols were set 
     up, including ready access to resources such as pain 
     specialist and multidisciplinary pain clinics. VA updated its 
     Computerized Patient Record System (CPRS) to document a 
     patient's pain history. Patient and family education about 
     pain management was included in patient treatment plans.
       Evaluation of Outcomes and Quality of Pain Management: VA 
     began to systematically measure outcomes and quality of pain 
     management, including patient satisfaction measures. Across 
     the nation, VA set up quarterly data collection to evaluate: 
     Was the patient assessed for pain using a 0-10 scale? Was 
     there intervention if pain was reported as 4 or more? Was 
     there a plan for pain care? Was the intervention evaluated 
     for effectiveness?
       Research: VA expanded research on management of acute and 
     chronic pain, emphasizing conditions that are most prevalent 
     among veterans. Currently, there are nine pain research 
     projects funded by VA. Research funded by the Health Services 
     Research and Development Service focuses on identifying 
     research priorities, providing scientific evidence for pain 
     management protocols throughout VA and evaluating and 
     monitoring the quality of care.


                 education of health care professionals

       VA is assuring that clinical staff, such as physicians and 
     nurses, have orientation and education on pain assessment and 
     pain management. In collaboration with the Department of 
     Defense and the community, VA is developing clinical 
     guidelines for pain associated with surgery, cancer and 
     chronic conditions.
       Additionally, VA initiated an extensive education program 
     for health care providers that includes orientation for new 
     employees and professional trainees, four internet sessions 
     on ``pharmacotherapy of acute and chronic pain,'' satellite 
     broadcasts and interactive sessions with VA health care 
     facilities, guest lectures on topics like pain assessment and 
     treatment of the demented, purchase and distribution of pain 
     management videos, and a Web site ``vaww.mst.lrn.va.gov/
     nmintranet/pain.''
       VA also focuses on pain management education for medical 
     students and health care professional trainees through VA's 
     affiliations with academic institutions. Among recent 
     milestones:
       The Robert Wood Johnson Foundation last year awarded VA a 
     grant of $985,595 to help train physicians in end-of-life 
     care, including pain management.
       The VA Office of Academic Affiliations recently awarded 
     additional funding to nine VA medical facilities to support 
     graduate education residences in anesthesiology pain 
     management, including VA medical centers in Milwaukee, Wis.; 
     Durnham, N.C.; and Loma Linda, Calif. and the health care 
     systems in North Texas, New Mexico, Puget Sound (Wash.), Palo 
     Alto (Calif.), and North Florida-South Georgia.


                   national pain management strategy

       The complexity of chronic pain management is often beyond 
     the expertise of a single practitioner, especially for 
     veterans whose pain problems are complicated by such things 
     as homelessness, post traumatic stress disorder and combat 
     injuries. Additionally, pain management has been made an 
     integral part of palliative and end-of-life care. The 
     effective management of pain for all veterans cared for by VA 
     requires a nationwide coordinated approach. To accomplish 
     this, VA formed a team made up of representatives from an 
     array of disciplines--anesthesiology, nursing, psychiatry, 
     surgery, oncology, pharmacology, gerontology and neurology.
       Funded by an unrestricted educational grant, VA is 
     producing a Web-based physician education program aimed at 
     end-of-life issues and an online forum for VA pain management 
     in which more than 200 clinicians actively participate.
       In December 2000, a pain management and end-of-life 
     conference is scheduled to showcase innovation and effective 
     practices within VA, address specialized topics with expert 
     faculty and solve systematic problems that cause barriers to 
     improving pain management care. Additionally, VA will set up 
     programs to support clinicians in settings that are remote 
     from pain experts, centers or clinics.
       ``Untreated or undertreated pain takes its toll not just in 
     monetary loss but also in the psychosocial and physical cost 
     to patients and their families. Pain can exacerbate feelings 
     of distress, anxiety and depression. . . . When severe pain 
     goes untreated and/or depression is present, some people may 
     consider or attempt suicide. The message is clear: all those 
     in pain have the right to systematic assessment and ongoing 
     management of pain by health care professionals.''--(The 
     Journal of Care Management, November 1999)

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