WHEN THE PAIN WON'T GO AWAY.

Byline: Evan Henerson Staff Writer

``I need something for the pain.''

There you have it: the most basic request a patient can make of a doctor or member of his medical staff. It's the No. 1 reason people see a doctor in the first place. Something hurts. Make it stop hurting.

So why is the request - and the subject of pain - such a puzzler for the medical community? Why can't more physicians treat pain?

Pain researchers expect the topic - and the definition - of pain to get more attention. Effective this year, a set of standards passed by the Joint Commission on the Accreditation of Healthcare Organizations requires hospitals and other medical facilities to recognize a patient's right to appropriate assessment and treatment of pain and to educate patients and their families about pain. Facilities found not to be complying with the JCAHO standards risk losing their accreditation.

``Pain is a major public-health issue, and the Joint Commission believes that these standards can have a significant impact in the assessment and management of pain,'' said Janet McIntyre, a JCAHO spokeswoman. ``In the past, many hospitals may have already been doing what the standards require, but many weren't.''

The standards do not primarily address the sharp, ``I-just-walloped- my-crazy-bone'' stinging or the discomfort that inevitably follows surgery or accompanies childbirth. Time's healing touch, a properly administered dose of medication or both can usually take care of what doctors call acute pain.

More difficult to treat is chronic pain - a recurring headache, throbbing back or pain somewhere in your vital organs that doesn't show up on an X-ray or any other kind of diagnostic test. If there's nothing to be seen, there's nothing to remove.

And untreated pain only makes the problem worse, said Dr. Leon Robb, an anesthesiologist who runs three branches of the Robb Pain Management Group, including one in North Hollywood.

``What we found early on was that a lot of patients, because they had pain for a long time, or because it was untreated or undiagnosed, they developed severe emotional problems associated with it,'' said Robb. ``They suffered depression, hysteria, some extensive hypochondriasis.''

``I used to do a lot of counseling,'' he added. ``I spent more time studying psychological problems than I did in learning specialized interventional procedures. I felt this was all part of treating the patient for pain.'' For patients with recurring pain, it often still is. Feeling better isn't as simple as swallowing a pill. Getting any kind of treatment is difficult enough.

Leana Baer suffered from lesions on her face that she characterizes as feeling like ``salt on an open wound.'' Doctors at several different medical centers were unable to explain the lesions or make them disappear.

``They didn't have a diagnosis, so they weren't going to do anything,'' said Baer, a dental hygienist who lives in Thousand Oaks. ``That's not OK. When people are in pain, pain is real.''

Toby Jenkins, who suffered from chronic pancreatitis, experienced lengthy periods of such excruciating discomfort that he was left incapacitated. During pain-free periods, he would dread the next attack.

``You want to die. You really do,'' said Jenkins, who lives in Lake Los Angeles. ``It's just unbearable, sitting and screaming, and there's nothing anybody can do.''

Encounters with severe pain aren't so uncommon, says Dr. Barnett Mayerson, physician manager and coordinator of the Pain Medicine Clinic at Kaiser Permanente's Panorama City Medical Center, where both Baer and Jenkins received treatment. Yet for so many doctors, no diagnosis means no treatment.

``(Euthanasia practitioner) Dr. (Jack) Kevorkian was so popular for so many years, and I'd say 90 percent of his patients had pain that was inadequately managed,'' said Mayerson. ``It's because of a lack of awareness on the part of the medical establishment. A lot of the time we were ignoring the patients when they were saying, 'I hurt really bad and I'd like some relief.' ''

The problem hasn't always been as simple as medical negligence. Many doctors hesitated to put their patients on pain medication for fear they would become addicted.

Now things are starting to change - both in terms of new treatments available and the pressure being placed on doctors to do something when a patient tells them ``I hurt.''

The JCAHO standards are a step in the right direction, says Mayerson, who claims the field of pain management is finally ``starting to emerge from the darkness.''

``To me, (set standards) is the support that medical programs need,'' he said. ``We're still talking about an infant science. The recommendations are trying to break down the barriers of pain-control awareness, and their intention is rather serious. People can't ignore it anymore.

``A year and a half ago, I gave a lecture to 27 (medical) residents, and not one of them had been given a single course in pain management,'' Mayerson added. ``This will help support education.''

How patients will experience the benefits of the new pain standards will vary. It may start with a member of the medical staff asking a patient to describe his pain or rate the pain he is feeling at the moment on a scale of zero to 10. A rating of zero means no pain, while 10 is the worst pain he has ever encountered.

Or a patient might be sitting in a waiting room with a posted sign that makes it clear: ``At this hospital, we will believe you when you say you are in pain, and we will take action to help you.''

Pain management specialists and JCAHO officials say pain assessment should be considered one of the vital sign checks during a routine physical examination - along with blood pressure, weight and temperature.

By the time they reach a pain specialist like Mayerson or Robb, patients have often been through primary-care physicians and have tried several courses of treatment - unsuccessfully. Pain specialists have access to everything from counseling and support groups to biofeedback and acupuncture. Drugs regimens are an option, as are surgical implants of devices designed to interrupt pain signals to the brain.

In an effort to get rid of her face pain, Baer said she tried everything, including a series of nerve-block injections into the nerves around her neck. Between the blocks and being numbed by local anesthetics, Baer said she became ``needle phobic.''

Ultimately, she elected to have a spinal chord stimulator implanted in her hip which allows her to send electrical signals up her spinal cord, converting the pain sensations to tingling. A day after the implant, Baer said her face was pain-free, although her back was sore from the procedure.

Unlike Baer, Jenkins had a diagnosis, but no relief. Ultimately, he had a pump implanted in his abdomen that dispenses morphine into his spine. The pump provided relief, but Jenkins eventually had his pancreas removed, making him a diabetic, but leaving him pain-free. Once he's weaned from the morphine, the pump will be refilled with a saline solution.

``Even when I was on massive doses of morphine, I could do anything,'' he said. ``The only way you'd know is when I'd go through an airport medical detector.''

CAPTION(S):

5 photos

Photo:

(1 -- cover -- color) Give me something for the PAIN

That's what doctors do, right?

Not always, says a commission that has set new standards medical professionals must meet when managing our throbbing aches

(2) Leana Baer, a pain patient at Kaiser Permanente Medical Center in Panorama City, shows the spinal chord stimulator she has had surgically implanted to alleviate pain from facial lesions.

(3) The pain center at Kaiser Medical Center in Panorama City treats patients with many types of chronic pain.

(4) Toby Jenkins shows the internal morphine drip that he had implanted to relieve pain from chronic pancreatitis.

(5) Dr. Max Wirjo, chief of anesthesia at Kaiser Permanente in Panorama City, talks with a pain patient.

Tom Mendoza/Staff Photographer