Control of acute pain in postoperative and post-traumatic situations and the role of the acute pain service

Abstract 

There has been considerable investment in services that promote the effective management of acute pain. Despite acute pain teams being normal practice in UK hospitals and an increasing volume of guidance, there are still a substantial number of patients who suffer moderate or severe acute pain. Acute pain teams improve analgesia, reduce side effects and improve safety on the basis of comparative studies. Simple scales for assessing pain are effective. Assessment may be more difficult in certain patient groups such as babies, infants and children, elderly patients and non-English speakers. Assessment for the symptoms and signs of neuropathic pain is important when nerve injury is suspected. Effective pain management obtunds the adverse effects of the injury response and may reduce the risk of chronic postsurgical pain. Preventive analgesia in terms of reducing postoperative pain and/or analgesic use is associated with the use of local anaesthetics, opioids or N-methyl-d-aspartate antagonists. Paracetamol is an effective analgesic and lowers the number needed to treat of other analgesics. The use of non-steroidal anti-inflammatory drugs is limited by side effects. Tramadol has important non-opioid mechanisms that widen its scope. In the future there will be a greater focus on those areas where current pain control approaches are of limited benefit.

Keywords: acute-on-chronic pain, chronic postsurgical pain, opioid tolerance, patient-controlled analgesia