• Mitch Keamy Photo Mitch Keamy is an anesthesiologist in Las Vegas Nevada Andy Kofke Photo Andy Kofke is a Professor of Neuro-anesthesiology and Critical Care at the University of Pennslvania Mike O'Connor Mike O'Connor is Professor of Anesthesiology and Critical Care at the University of Chicago Rob Dean Photo Rob Dean is a cardiac anesthesiologist in Grand Rapids Michigan, with extensive experience in O.R. administration.

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Counting Sheep

I suppose one could argue that a sign is an objective descriptor (ie - a vital sign, or an oxygen saturation), while a symptom is subjective (ie - pain). But where JCAHO is concerned, all the rules are broken.

Good article.

Mike O'Connor

These are extracts of a communication from someone who prefers to remain off the radar:

JCAHO was just at XXXXXXXX and it was so annoying. I hate when I see pts in the hospital and have to ask them whether or not they are in pain, whether or not it makes sense. Pain is generally not one of those things that pts keep from you--pain is usually one of the 1st things they tell you. " The 5th vital sign" it is so ridiculous and so out of touch!

It is interesting to me, I thougt pain med seekers were a YYYYYYYYYYYYYYY thing. I did not realize that it was a common trend. These chronic pain pts on narcs are generally pretty nasty. They prey on young and inexperienced physicians. They try to get appts with interns in July of their 1st year. All of the chronic pain pts are supposed to have a pain consult, a psych consult, and a PCP. They are emotionally draining pts and doctor shop. It is often the pharmacists who call us to let us know that pts are getting narcs from more than one doc. As a PCP it is hard to know if you are the only one prescribing the meds.

I hate opiate contracts. I feel like I am signing up to give narcs period, whether or not they are appropriate. How is this good medicine? I feel like the contract puts me in a bind rather than makes pts less abusive. It feels demeaning, elementary schoolesque.


There are some people who do take there meds as needed,I did when I was 18 I took everything as needed.Then I made the mistake of doing powder cocaine at 18, I was discharged, I like to have died I started having siezures,Iended up in ICU.I have been on pain meds since I was 8.I found anouther DR. who took care of what I needed 2 years later, I did powder again and I as last time was discharged.Now I am 38 noone will help me I am as bas as they come and none will help me


God forgives why cant pain clinics, its caused me to become, Bipolar, depression, Manic, and very suicdal,and I still want to die bacause of my pain.

Mike O'Connor

UNKNOWN has two comments to my post, both of which are provocative and informative. Real or not, they're worthy of a response.

Pain has many causes. Pain can be a substantial component of both neurologic and psychiatric disease. Worse, in both instances, the absence of an apparent physical explanation has delayed the acceptance of this truth and systematic investigation of both cause and treatment.

Psychiatric disease is extraordinarily difficult to treat under the best of circumstances, and sadly it is the destiny of almost all psychiatric patients to be treated in the worst of circumstances, as their disease makes them uninsured/uninsurable in a world where insurers balk at paying for psychiatric care (which is staggeringly expensive). Hence most patients with significant psychiatric disease end up living on the fringes of our society, and at the bottom of the economic ladder, receiving whatever care is available to the indigent and uninsured.

Substance abuse is a significant component of some psychiatric disease (especially Bipolar disorder), and can cause or worsen others (e.g. the increasing association between cannabis abuse and psychosis). Worse, the liability associated with prescribing controlled substances to a non-compliant patient psychiatric patient with a history of substance abuse is insuperable. Even if there were no liability, compassionate practitioners might well judge that the risk to the patient from any such prescription might well surpass any benefit the patient might derive.

UNKNOWN: Good Luck.


I'm an old woman; I had not been in a hospital since having babies when I was much younger (when they drugged us to the gills). I didn't watch medical tv shows nor had I ever seen a medical blog. Then I was hospitalized for a broke hip. I remember a nurse asking me occasionally to "rate your pain, one to ten". I had no idea what she was talking about, but she was so solicitous and kind that I wanted, in my wooze, to comply, so I'd give her a number, trying to vary it so as not to be boring or seem to be making it up. I never felt the slightest tinge of pain while in the hospital, just slept and rested, got up into the chair without assistance twice a day and never could stay awake long enough to eat more than two bites at mealtimes. After two days, I went home very hungry and with pain meds, but stopped them after a couple of days (constipating) because I could manage the pain with a couple of tylanol in the evenings and otherwise with ice packs and heating pad. I believe the hospital and the surgeon are the best in the country (I've since had experiences elsewhere to compare) and am so grateful to them for everything.

Health remedies

Great Poggy, I'm agreed with you.

Van Sales

I visited this blog first time and found it very interesting and informative.. Keep up the good work thanks..


What if you truly are a chronic pain patient? I go to 1 dr, and the only time add'l narcs are prescribed are in a hospital situation as I've had many surgeries in addition to major back injury. Not crazy about the contract, but it was a promise to shop only 1 pharmacy and not go to other docs which I don't do anyway. The only time it can be a problem is when my pharmacy is out of stock then I call for permission and they note my chart. Each month I feel a weight of judgment on my shoulders when I have done NOTHING wrong!! Have your chest cut open 3 times & get back to me. Is it possible for their to be true chronic pain sufferers & the "bad apples" have caused these problems?

Michael O'connor


You are absolutely not the problem. There is no question that there are a large number of real chronic pain patients out there deserving of the highest level of care that we can provide. People like you.

It is the bad apples that have caused these problems. Thanks for pointing out to me something that escaped me in my original post: all of this does make legitimate patients feel guilty, even when they have done nothing wrong.


I'm a nursing student and am thrilled to see this information. I wish I could bring this to class, but would probably be thrown out on my keester for blaspheming the Holy JACO.

Thank you for this.

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