Relieving the agony of the new pain management standards.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has issued new standards for pain assessment in accredited hospitals and other health care settings, including hospice and home care. Under the new pain management standards, health care facilities will be called upon to recognize the right of patients to appropriate assessment and management of pain; to assess the existence of pain, its nature, and intensity; to record the results of the assessment in a way that facilitates regular reassessment and follow-up; to determine and ensure staff competency in pain assessment and management, and to address pain assessment and management in the orientation of all new staff; to establish policies and procedures that support the appropriate prescription or ordering of effective pain medications; to educate patients and their families about effective pain management; and to address patient needs for symptom management in the discharge planning process. Many health care organizations are reporting confusion and lack of understanding about the scope of the new standards. To address this issue, this article summarizes the new pain management standards. This article is based on a three-part series published in the Journal of Healthcare Safety, Compliance & Infection Control (January, March, and April 2000).

Tibial tubercle apophysitis in cerebral palsy treated with proximal tibial epiphysiodesis: report of two cases with 3-year follow-up.

Tibial tubercle apophysitis, or Osgood-Schlatter disease, is a condition not commonly seen in conjunction with cerebral palsy. The reported radiologic incidence of this association is only 3%. The condition usually responds to conservative therapy, consisting of rest, immobilization, and antiinflammatory agents. Occasionally, a child with cerebral palsy and resistant apophysitis requires surgical intervention. We report two patients with bilateral apophysitis who underwent proximal tibial epiphysiodesis with complete relief of symptoms and rapid return to community ambulation.

Passive motion therapy for infants with arthrogryposis.

A comprehensive program for treatment of arthrogryposis multiplex congenita has been developed based on experiences with 95 infants and young children with arthrogrypotic deformities. The regimen emphasizes early passive stretching and serial splinting to improve joint motion. Ninety percent of the patients had contractures of all extremities; 40% had multiple congenital anomalies. Daily intensive passive stretching of joints and serial splinting have substantially increased patient function in this population. Surgical procedures have been used only in cases in which persistent deformities require correction.

Treatment of extension contracture of the hip in cerebral palsy.

Twenty patients with cerebral palsy had a total of 35 extension contractures of the hip, resulting from tightness of the gluteus maximus or hamstring muscles, with associated quadricepts muscle spasticity. Associated deformities included anteriorly dislocated hips, patella alta, lumbar lordosis, thoracic kyphosis and calcaneus feet. Active and passive exercises, surgical release of contractures and reduction of anteriorly dislocated hips improved function. Hip flexor or adductor tenotomies must be considered cautiously for patients with spastic hip extensor muscles, because severe extension constricture may develop after either procedure.