title: Improving the management of post-operative acute pain: priorities for change.
abstract: Poor management of post-operative acute pain can contribute to medical complications including pneumonia, deep vein thrombosis, infection and delayed healing, as well as the development of chronic pain. It is therefore important that all patients undergoing surgery should receive adequate pain management. However, evidence suggests this is not currently the case; between 10% and 50% of patients develop chronic pain after various common operations, and one recent US study recorded >80% of patients experiencing post-operative pain. At the first meeting of the acute chapter of the Change Pain Advisory Board, key priorities for improving post-operative pain management were identified in four different areas. Firstly, patients should be more involved in decisions regarding their own treatment, particularly when fateful alternatives are being considered. For this to be meaningful, relevant information should be provided so they are well informed about the various options available. Good physician/patient communication is also essential. Secondly, better professional education and training of the various members of the multidisciplinary pain management team would enhance their skills and knowledge, and thereby improve patient care. Thirdly, there is scope for optimizing treatment. Examples include the use of synergistic analgesia to target pain at different points along pain pathways, more widespread adoption of patient-controlled analgesia, and the use of minimally invasive rather than open surgery. Fourthly, organizational change could provide similar benefits; introducing acute pain services and increasing their availability towards the 24 hours/day ideal, greater adherence to protocols, increased use of patient-reported outcomes, and greater receptivity to technological advances would all help to enhance performance and increase patient satisfaction. It must be acknowledged that implementing these recommendations would incur a considerable cost that purchasers of healthcare may be unwilling or unable to finance. Nevertheless, change is under way and the political will exists for it to continue.
authors.affiliation: a a Leiter der Sektion Schmerz, Klinik für Anaesthesiologie und Intensivmedizin, Universitätsklinikum der FSU Jena , Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Meissner
authors.affiliation: b b Department of Medical and Surgical Sciences and Biotechnologies , Sapienza University of Rome , Italy.
authors.forename: Flaminia
authors.initials: F
authors.lastname: Coluzzi
authors.affiliation: c c Service Anesthésie Réanimation, Hôpital Raymond Poincare , Garches , France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Fletcher
authors.affiliation: d d University Hospital , Rotterdam , The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Huygen
authors.affiliation: e e University Hospitals Leuven , Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Morlion
authors.affiliation: f f Faculty of Health , School of Medicine, Witten/Herdecke University , Cologne , Germany.
authors.forename: Edmund
authors.initials: E
authors.lastname: Neugebauer
authors.forename: Antonio
authors.initials: A
authors.lastname: Montes
authors.affiliation: h h Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA.|i i Naples Anesthesia and Pain Associates , Naples , FL , USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Pergolizzi
mesh_terms: D059787:Acute Pain / Q000628:therapy*; D000698:Analgesia / Q000379:methods*; D003142:Communication; D006801:Humans; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D017060:Patient Satisfaction
keywords: Organizational change; Patient controlled analgesia; Patient involvement; Post-operative acute pain; Professional education; Synergistic analgesia; Treatment optimization