The Efficacy and Safety of Pain Management Before and After Implementation of Hospital-Wide Pain Management Standards: Is Patient Safety Compromised by Treatment Based Solely on Numerical Pain Ratings?

Abstract

Although patient satisfaction with pain management has significantly improved since the adoption of pain management standards, adverse drug reactions have more than doubled. For the treatment of pain to be safe and effective, we must consider more than just a one-dimensional numerical assessment of pain.

Postoperative pain assessment based on numeric ratings is not the same for patients and professionals: A cross-sectional study

“…Unnecessary opioid administration also increases the probability of sedation and potentially dangerous respiratory depression (Cashman and Dolin, 2004;Taylor et al, 2005). An increase of opioid oversedation is reported after the implementation of the new standards of the Joint Commission (Vila et al, 2005). Therefore, to balance the risks of overtreatment and undertreatment in this range of numerical pain scores, the health care provider might simply add the following question: ''would you like to have an analgesic?''…”

Effective Pain Management and Improvements in Patients’ Outcomes and Satisfaction

“…The dimensions have physiological, sensory, affective or cognitive, and sociocultural components unique for each patient that should be considered. 5 Research on pain management in the 1970s and 1980s peaked as a breakthrough in theoretical knowledge of the physiological, psychological, and social aspects of improved quality of life associated with pain relief, but application of the findings to the general practice of medicine have been delayed. 6 Aggressive pain control is still lacking for patients with acute pain.…”

“…6 Aggressive pain control is still lacking for patients with acute pain. 5,7 Although some concepts have been integrated into practice to enhance effective pain management, application of the concepts in the treatment of patients with pain has been slow, [7][8][9] despite the availability of efficacious analgesics and multiple published clinical practice guidelines for management of acute pain. 2,7 The American Pain Society published the most current guidelines 10 in 2005 for improving the management of acute pain and cancer pain (the initial guidelines were released in 1995).…”

“…5 Analgesia gaps can occur while a patient is emerging from anesthesia, being transferred from a postanesthesia care unit to a surgical unit, having the route of administration changed from epidural to intravenous to oral, and during progression in mobility. By astutely identifying anticipated postoperative phases that might require additional analgesia during a patient's acute recovery, nurses can avoid interruptions in pain therapies.…”

La prise en charge de la douleur après une chirurgie ambulatoire: où est-ce que ça coince?

“…Vila et coll. 9 ont rapporté que, en conséquence de la directive concernant la prise en charge de la douleur mise en place par le JCAHO, l'incidence d'effets secondaires liées à l'utilisation d'opiacés est passée de 11 à 25 par 100 000 patients-jours d'hospitalisation dans leur centre médical. La plupart du temps, la survenue d'effets secondaires aux médicaments étaient précédés d'une réduction documentée du niveau de conscience du patient en raison d'une sédation provoquée par un opiacé.…”