Pain and suffering in seriously ill hospitalized patients

BACKGROUND: Previous studies had suggested a high prevalence of pain in hospitalized patients but had not specifically evaluated pain and other symptoms in seriously ill and older hospitalized patients. OBJECTIVE: The SUPPORT and HELP studies were designed to (1) assess the frequency and severity of pain and other symptoms during hospitalization 2 and 6 months later, and before death; (2) identify factors associated with pain and other symptoms; and (3) test an intervention to improve pain. DESIGN: An observational cohort and randomized controlled trial. SETTING: Five major teaching hospitals in the US. PATIENTS: Hospitalized patients aged 80 years and older or with one of nine serious illnesses. INTERVENTION: Education of patients and family members about pain control, monitoring of patients' pain, and feedback about pain with treatment suggestions to nurses and physicians. MEASUREMENTS: Data from the medical record and interview-based information about pain and other symptoms and preferences for care and symptom control from patients and family members. RESULTS: Pain and other symptoms were frequent and often severe in seriously ill and older patients during hospitalization, at follow-up, and before death, even in those with diseases not traditionally associated with pain. There was wide variation in symptom experience across hospitals. Patients' preference for pain control was not associated with symptom experience. The intervention did not improve pain control. CONCLUSIONS: Control of pain and other symptoms remains an important medical and ethical issue. Routine monitoring of pain and other symptoms should be linked to treatment strategies aimed at combinations of symptoms and tested to assuage concerns about side effects.