Home Medicine How can pain management be improved in hospitalized patients?
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How can pain management be improved in hospitalized patients?

  • Lone Nikolajsen EMAIL logo and Nina Buch
Published/Copyright: April 1, 2017
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Scandinavian Journal of Pain
From the journal Scandinavian Journal of Pain Volume 15 Issue 1

In this issue of the Scandinavian Journal of Pain, Andersson and co-workers publish a study on pain reduction in hospitalized patients following an intervention consisting of staff education, implementation of evidence-based pain management guidelines, and an organization that includes pain responsibility nurses. Data on pain intensity, use of pain rating scales, and analgesic medication were collected before (306 patients) and after (293 patients) the intervention, which took place at two hospitals in southwest Sweden between 2009 and 2010 [1]. The authors found an increase in the use of pain rating scales and a more appropriate prescription of analgesics following the intervention but there was no difference in recordings of patients pain intensity.

1 Pain in hospitalized patients

It has consistently been documented that pain remains undertreated in hospitalized patients and that this situation applies to all patient categories [2,3]. Therefore, Andersson and co-workers should be acknowledged for the inclusion of patients from both surgical and medical wards and with different pain conditions: 65% had acute pain,11% had cancer pain, and 24% had chronic pain conditions. According to their study, the number of patients with moderate to severe pain at rest was equally high in all three patient groups regardless of the reason for their pain [1]. This finding confirms that it is very important to pay attention to patients with chronic pain conditions in medical wards. Such patients are less likely to receive care from an Acute Pain Services unless they undergo surgery.

2 Interventions to reduce pain

Several efforts have been made over the years in order to optimize the management of pain in hospitalized patients. As regards the treatment of postoperative pain, these efforts include the introduction of Acute Pain Services [4] and increased use of multimodal and regional analgesia [5]. Other efforts include implementation of pain treatment guidelines, use of validated pain rating instruments, and education of staff as described by Andersson and co-workers. The latter type of intervention has the potential to improve pain management for all patients and not only for postsurgical patients. Unfortunately, Andersson and co-workers could not demonstrate any effect of their intervention on the pain intensity in hospitalized patients [1]. This finding is in concordance with results from other recent studies [6,7].

3 Challenges with study design

There are several challenges with study design when documenting the effect of interventions like the ones used in the study by Andersson et al. [1]. Many authors use a before and after design, but this approach can make it difficult to distinguish the effects of the intervention from the effects of increased awareness of pain or – as regards postoperative pain – improvements in anaesthetic, analgesic, or surgical techniques over time. Likewise, when using a before and after design, the lack of effect could be explained by changes in the patient population as patients become elder and more comorbid. Ideally, randomization of different departments to +/− intervention would be preferable, but results would remain difficult to interpret as departments differ in terms of patient categories, treatment strategies, organizational structures, and doctors’ and nurses’ clinical competencies.

4 Conclusion and implications

In conclusion, Andersson and coworkers should be acknowledged for their efforts to improve the management of pain in hospitalized patients. Although there was no effect of the intervention on the patients’ pain, the use of pain rating scales increased their pain awareness and analgesics were prescribed more appropriately [1]. Their findings confirm that improving pain management is complex and that a continuous ongoing effort is needed, which – among others – includes teaching of doctors and nurses, patient education, implementation of guidelines, and the establishment of an Acute Pain Service. Acute pain services should not only focus on the monitoring of blocks and epidurals in otherwise uncomplicated surgical patients. An equally important task is to help ensure adequate pain treatment for all patients with acute pain, regardless of whether the pain is caused by infection, ischaemia, trauma or surgery, and regardless of whether the patient is admitted to a surgical or medical ward.

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2016.11.006.

Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Norrebrogade 44, DK-8000 Aarhus C, Denmark.Tel.: +45 7846 4317.

  1. Conflict of interest: None declared.

References

[1] Andersson V, Bergman S, Henoch I, Ene KW, Otterström-Rydberg E, Simonsson H, Ahlberg K. Pain and pain management in hospitalized patients before and after an intervention. Scand J Pain 2017;15:22–9.Search in Google Scholar

[2] Gregory J, McGowan L. An examination of the prevalence of acute pain for hospitalised adult patients: a systematic review. J Clin Nurs 2016;45:583–98.Search in Google Scholar

[3] Dix P, Sandhar B, Murdoch J, MacIntyre PA. Pain on medical wards in a district general hospital. Br J Anaesth 2004;92:235–7.Search in Google Scholar

[4] Nielsen PR, Christensen PA, Meyhoff CS, Werner MU. Post-operative pain treatment in Denmark from 2000 to 2009: a nationwide sequential survey on organizational aspects. Acta Anaesth Scand 2012;56:686–94.Search in Google Scholar

[5] Kehlet H, Dahl J. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg 1993;77:1048–56.Search in Google Scholar

[6] Sturesson L, Falk AC, Castrèn M, Niemi-Murola L, Lindström V. Mandatory documentation of pain in the emergency department increases analgesic administration but does not improve patients’ satisfaction of pain management. Scan J Pain 2016;13:32–5.Search in Google Scholar

[7] Friesgaard DK, Paltved C, Nikolajsen L. Acute pain in the emergency department: effect of an educational intervention. Scand J Pain 2017;15:8–13.Search in Google Scholar
Published Online: 2017-04-01
Published in Print: 2017-04-01

© 2017 Scandinavian Association for the Study of Pain

Articles in the same Issue

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. Cardiovascular risk reduction as a population strategy for preventing pain?
  5. Observational study
  6. Diabetes mellitus and hyperlipidaemia as risk factors for frequent pain in the back, neck and/or shoulders/arms among adults in Stockholm 2006 to 2010 – Results from the Stockholm Public Health Cohort
  7. Editorial comment
  8. Exercising non-painful muscles can induce hypoalgesia in individuals with chronic pain
  9. Clinical pain research
  10. Exercise induced hypoalgesia is elicited by isometric, but not aerobic exercise in individuals with chronic whiplash associated disorders
  11. Editorial comment
  12. Education of nurses and medical doctors is a sine qua non for improving pain management of hospitalized patients, but not enough
  13. Observational study
  14. Acute pain in the emergency department: Effect of an educational intervention
  15. Editorial comment
  16. Home training in sensorimotor discrimination reduces pain in complex regional pain syndrome (CRPS)
  17. Original experimental
  18. Pain reduction due to novel sensory-motor training in Complex Regional Pain Syndrome I – A pilot study
  19. Editorial comment
  20. How can pain management be improved in hospitalized patients?
  21. Original experimental
  22. Pain and pain management in hospitalized patients before and after an intervention
  23. Editorial comment
  24. Is musculoskeletal pain associated with work engagement?
  25. Clinical pain research
  26. Relationship of musculoskeletal pain and well-being at work – Does pain matter?
  27. Editorial comment
  28. Preoperative quantitative sensory testing (QST) predicting postoperative pain: Image or mirage?
  29. Systematic review
  30. Are preoperative experimental pain assessments correlated with clinical pain outcomes after surgery? A systematic review
  31. Editorial comment
  32. A possible biomarker of low back pain: 18F-FDeoxyGlucose uptake in PETscan and CT of the spinal cord
  33. Observational study
  34. Detection of nociceptive-related metabolic activity in the spinal cord of low back pain patients using 18F-FDG PET/CT
  35. Editorial comment
  36. Patients’ subjective acute pain rating scales (VAS, NRS) are fine; more elaborate evaluations needed for chronic pain, especially in the elderly and demented patients
  37. Clinical pain research
  38. How do medical students use and understand pain rating scales?
  39. Editorial comment
  40. Opioids and the gut; not only constipation and laxatives
  41. Observational study
  42. Healthcare resource use and costs of opioid-induced constipation among non-cancer and cancer patients on opioid therapy: A nationwide register-based cohort study in Denmark
  43. Editorial comment
  44. Relief of phantom limb pain using mirror therapy: A bit more optimism from retrospective analysis of two studies
  45. Clinical pain research
  46. Trajectory of phantom limb pain relief using mirror therapy: Retrospective analysis of two studies
  47. Editorial comment
  48. Qualitative pain research emphasizes that patients need true information and physicians and nurses need more knowledge of complex regional pain syndrome (CRPS)
  49. Clinical pain research
  50. Adolescents’ experience of complex persistent pain
  51. Editorial comment
  52. New knowledge reduces risk of damage to spinal cord from spinal haematoma after epidural- or spinal-analgesia and from spinal cord stimulator leads
  53. Review
  54. Neuraxial blocks and spinal haematoma: Review of 166 case reports published 1994–2015. Part 1: Demographics and risk-factors
  55. Review
  56. Neuraxial blocks and spinal haematoma: Review of 166 cases published 1994 – 2015. Part 2: diagnosis, treatment, and outcome
  57. Editorial comment
  58. CNS–mechanisms contribute to chronification of pain
  59. Topical review
  60. A neurobiologist’s attempt to understand persistent pain
  61. Editorial Comment
  62. The triumvirate of co-morbid chronic pain, depression, and cognitive impairment: Attacking this “chicken-and-egg” in novel ways
  63. Observational study
  64. Pain and major depressive disorder: Associations with cognitive impairment as measured by the THINC-integrated tool (THINC-it)
https://doi.org/10.1016/j.sjpain.2017.01.002

Articles in the same Issue

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. Cardiovascular risk reduction as a population strategy for preventing pain?
  5. Observational study
  6. Diabetes mellitus and hyperlipidaemia as risk factors for frequent pain in the back, neck and/or shoulders/arms among adults in Stockholm 2006 to 2010 – Results from the Stockholm Public Health Cohort
  7. Editorial comment
  8. Exercising non-painful muscles can induce hypoalgesia in individuals with chronic pain
  9. Clinical pain research
  10. Exercise induced hypoalgesia is elicited by isometric, but not aerobic exercise in individuals with chronic whiplash associated disorders
  11. Editorial comment
  12. Education of nurses and medical doctors is a sine qua non for improving pain management of hospitalized patients, but not enough
  13. Observational study
  14. Acute pain in the emergency department: Effect of an educational intervention
  15. Editorial comment
  16. Home training in sensorimotor discrimination reduces pain in complex regional pain syndrome (CRPS)
  17. Original experimental
  18. Pain reduction due to novel sensory-motor training in Complex Regional Pain Syndrome I – A pilot study
  19. Editorial comment
  20. How can pain management be improved in hospitalized patients?
  21. Original experimental
  22. Pain and pain management in hospitalized patients before and after an intervention
  23. Editorial comment
  24. Is musculoskeletal pain associated with work engagement?
  25. Clinical pain research
  26. Relationship of musculoskeletal pain and well-being at work – Does pain matter?
  27. Editorial comment
  28. Preoperative quantitative sensory testing (QST) predicting postoperative pain: Image or mirage?
  29. Systematic review
  30. Are preoperative experimental pain assessments correlated with clinical pain outcomes after surgery? A systematic review
  31. Editorial comment
  32. A possible biomarker of low back pain: 18F-FDeoxyGlucose uptake in PETscan and CT of the spinal cord
  33. Observational study
  34. Detection of nociceptive-related metabolic activity in the spinal cord of low back pain patients using 18F-FDG PET/CT
  35. Editorial comment
  36. Patients’ subjective acute pain rating scales (VAS, NRS) are fine; more elaborate evaluations needed for chronic pain, especially in the elderly and demented patients
  37. Clinical pain research
  38. How do medical students use and understand pain rating scales?
  39. Editorial comment
  40. Opioids and the gut; not only constipation and laxatives
  41. Observational study
  42. Healthcare resource use and costs of opioid-induced constipation among non-cancer and cancer patients on opioid therapy: A nationwide register-based cohort study in Denmark
  43. Editorial comment
  44. Relief of phantom limb pain using mirror therapy: A bit more optimism from retrospective analysis of two studies
  45. Clinical pain research
  46. Trajectory of phantom limb pain relief using mirror therapy: Retrospective analysis of two studies
  47. Editorial comment
  48. Qualitative pain research emphasizes that patients need true information and physicians and nurses need more knowledge of complex regional pain syndrome (CRPS)
  49. Clinical pain research
  50. Adolescents’ experience of complex persistent pain
  51. Editorial comment
  52. New knowledge reduces risk of damage to spinal cord from spinal haematoma after epidural- or spinal-analgesia and from spinal cord stimulator leads
  53. Review
  54. Neuraxial blocks and spinal haematoma: Review of 166 case reports published 1994–2015. Part 1: Demographics and risk-factors
  55. Review
  56. Neuraxial blocks and spinal haematoma: Review of 166 cases published 1994 – 2015. Part 2: diagnosis, treatment, and outcome
  57. Editorial comment
  58. CNS–mechanisms contribute to chronification of pain
  59. Topical review
  60. A neurobiologist’s attempt to understand persistent pain
  61. Editorial Comment
  62. The triumvirate of co-morbid chronic pain, depression, and cognitive impairment: Attacking this “chicken-and-egg” in novel ways
  63. Observational study
  64. Pain and major depressive disorder: Associations with cognitive impairment as measured by the THINC-integrated tool (THINC-it)
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