Guidelines on Acute Pain Management
Treatment of pain is fundamental to quality patient care.
Principles
- Pain may lead to adverse physiological and psychological efffects
- Effective post-operative pain management:
- Reduces morbidity
- Speeds discharge
- Must be tailored tto the patient
- Requires a multidisciplinary approach
- Requires formal protocols and guidelines
- Pain is affected by patient attitudes and beliefs
Clinical Manifestations
Assessment of analgesia:
- Must occur to tailor analgesic regimens
- Should be performed:
- Frequently
- At rest
- During activity
Physical therapy, mobilisation, coughing, deep breathing.
Pharmacological Therapies
Analgesics:
- May include:
- Opioids
- NSAIDS Local anaesthetics.
- Antidepressants
- Anticonvulsants
- Membrane stabilisers
- Should be carefully titrated
- Should be used in combination
Multimodal analgesia improves efficacy.
Acute Pain Services
A formalised, multidisciplinary pain service:
- Improves patient outcomes
Recommended for patients with complex medical or psychological pathology. - Should be run by medical personell
Anaesthetists and pain nurses. - Involve liason with paramedical teams
Physiotherapy, psychology, pharmacy. - Should develop specific policies, protocols, and guidelines
- Should review all patients under their care at least daily
- Should consult on acute pain and acute-on-chronic pain
- Should conduct regular audits of practice
Rights of the Patient
Patients with pain, have the right to:
- Have pain relief
Professional response be reasonable and proportionate to level and character of the pain experience. This does not mean that:- The pain will (or can) be treated successfully
- The patient will be free of pain
- That pain relief can be provided on demand
Notably opioids.
- Have their complaints respected and taken seriously
- Be cared for in a timely manner by health professionals trained and experienced in assessment and management of pain
- Participate actively in the education and goal development
- Have their pain history, assessment, and management documented so that optimal ongoing relief is provided
- Have access to best practice care
- Informed of the evidence of efficacy and liklihood of sucess of management, and of alternative therapies
- Have appropriate planning for pain management after discharge
Responsibilities of the Patient
Paients, carers, and families should:
- Engage openly
- Educate themselves about their pain and its management
- Participate actively in their own care, and decisions about their care
- Consider best-practice advice