Royal Devon and Exeter Hospital, Barrack Rd, Exeter, EX2 5DW, UK
*Corresponding author. E-mail: philippa@dixracwil.demon.co.uk
Accepted for publication: July 8, 2003
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Abstract |
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Methods. All consenting adult in-patients were assessed daily for 5 days. Patients recorded the occurrence and severity of pain, and whether their pain was bearable. The pain team reviewed patients with unbearable pain.
Results. 1594 questionnaires were completed, representing 54% of the target population. 887 patients reported pain, 17% with pain scores over 6, and 10% with unbearable pain. The distribution of pain was similar for all ward types with 52% of patients on medical wards reporting pain. Of these, 20% reported severe pain and 12% unbearable pain. When patients with pain scores over 6 were analysed by consultant specialty, elderly care, general medicine, and general surgery scored highest. In each specialty 2025% of patients with pain reported a pain score over 6. In patients reviewed by the pain team, reasons for poor analgesia included inadequate information, pain assessment, analgesic prescribing, and administration and patient reporting.
Conclusion. Patients in all hospital specialities experience pain. Until the issue of pain management in medical patients is fully addressed the situation will not improve.
Br J Anaesth 2004; 92: 2357
Keywords: pain, acute; pain, management; patient, medical
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Introduction |
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We were interested in determining the prevalence and severity of pain in the general medical setting, and how this compared with other clinical specialties.
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Methods |
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At the end of the 5-day period, patients were asked to prioritize one aspect of their pain management that they would improve. This allowed an opportunity for feedback and suggestions. The survey team consisted of members of the pain team, Clinical Audit Department, Department of Anaesthesia, and temporary staff recruited from an outside agency. A covering letter was given to all patients explaining the survey, and assuring confidentiality and anonymity.
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Results |
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The number of patients who reported having pain during the previous 24 h was 887. The distribution of reported pain was similar for surgical, medical, and orthopaedic wards (Fig. 1) with about 60% of patients reporting pain in the previous 24 h. Seventeen per cent of these recorded pain scores of 6 or more and there was little difference between general surgical and medical wards. Patients on all ward groups reported unbearable pain, although this was less common on the orthopaedic wards (5%), than on medical or surgical wards (12.5 and 10.5%, respectively).
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When patients with a pain score of 6 or over were categorized by consultant specialty there was little difference between the prevalence of pain in general medicine, care of the elderly or general surgery (Fig. 2).
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Discussion |
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The first stage in trying to improve pain control is to recognize and quantify the problem. Hopefully this study has achieved these aims and improvements can now be introduced. Interestingly, improved overall pain control was only the top priority for 16% of the medical patients in pain, with 39% wanting more information, and 29% wanting fewer side effects. The provision of information and treatment of side effects is relatively easy and are two of the core skills provided by the acute pain team. This suggests their involvement on the medical wards could provide easy but effective improvements in the pain management of medical patients. Other measures such as increasing staff and patient awareness of the importance of assessing and reporting pain, education of nursing and medical staff, and specific guidelines for analgesic prescribing (including treatment of side effects) may help reduce the number of patients reporting unbearable or severe pain. Such guidelines may be very different from those issued to surgical teams and may include specific strategies for medical and elderly care patients.
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References |
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2 The Royal College of Anaesthesists. Guidelines for the Provision of Anaesthetic Services. Guidance on Pain Management Services, 1999; 559
3 Audit Commission. Anaesthesia under Examination, 1997
4 Clinical Standards Advisory Group. Services for Patients with Pain. Department of Health, 1999