Managing acute pain

Educating management of acute pain
Researching control of acute pain

Context

Acute pain usually accompanies major surgery, particularly abdominal and orthopaedic surgery, or severe trauma such as fractured ribs. Unlike chronic pain, acute pain improves over time as the patient recovers but can be a major source of discomfort and distress.Although pain treatment is usually available, several obstacles have stood in the way of pain relief:

Fear of addiction: Although many of the best treatments for cancer pain are narcotics (also called opioids), addiction is very rare; fewer than one in 10,000 cancer patients who take drugs and were not dependent before will become addicts.

Loss of mental acuity: Recent advances allow delivery of medication in long-term, slow-acting form, which allows a baseline level of pain relief without the peaks and valleys of pain at some times and grogginess at other times.

Fear of side effects: Patients often take less than the prescribed dose of pain medicines because they are concerned about the side effects that may occur. Most side effects, however, can be prevented or relieved. The most typical side effects listed are nausea and constipation.

Inadequate knowledge: Health care professionals in the past were not well trained to care for patients with chronic pain and also were fearful of addiction.

Inadequate pain assessment: Patients might try to be tough rather than ask for relief of pain.

Legal obstacles: When prescribing narcotics, health care professionals sometimes feared action by law-enforcement agencies. These actions may be exaggerated by professionals and should not be an obstacle to pain relief.

Implementation

A study involving more than 10,000 patients has led to the development of radical changes in pain management by the Acute Pain Service (APS) in Australia. A principal finding which challenges conventional medical teaching and practice is that it is better to base drug dosage on the age of the patient. Other findings were that good pain relief can be provided without dangerous side effects, and that pain relief must be tailored to individual patients. APS has developed procedures and protocols of specialized pain relief and acute pain management.

Claim

90 percent of cancer patients could get their pain relieved by taking medicines delivered either in sustained-release pills or through a skin patch. If these treatments do not work well, other options are available: medicines delivered intravenously, by injection or by an implanted pump; surgery; nerve blocks; heat or cold therapy; massage; hypnosis; acupuncture; and transcutaneous electric nerve stimulation, which uses a mild electrical current applied to the skin at the site of pain.

One of the most helpful aspects of the guidelines is that they could popularize several assessment tools that provide a way for patients and doctors to describe pain objectively. One of the simplest is a number scale, in which zero indicates no pain and 10 represents the most severe pain. If we give the pain a number, doctors and patients can work together in a common goal to getting that pain number down to a level that's acceptable to the patient. This all normalizes it and turns it from a complaint to a symptom.