A survey of acute pain services in the United KingdomBMJ 1995; 311 doi: http://dx.doi.org/10.1136/bmj.311.7001.360 (Published 05 August 1995) Cite this as: BMJ 1995;311:360
- aDepartment of Anaesthetics and Intensive Care Medicine, University of Wales College of Medicine, Heath Park, Cardiff CF4 4XW
- Correspondence to: Dr Harmer.
- Accepted 5 August 1995
The report of a joint working party of the Royal College of Surgeons of England and the College of Anaesthetists to consider pain after surgery called for the development of an acute pain service in every hospital performing surgery.1 Despite this firm recommendation, it is perceived that such services are not as prevalent as might be expected. We undertook a survey of the current status of acute pain management in the United Kingdom.
Subjects, methods, and results
We sent a questionnaire to each of the tutors of the Royal College of Anaesthetists. The questionnaire sought details of the existence, staffing, and funding of any form of acute pain service in each hospital. An outline of the hospital's current methods of pain management after major surgery was also requested.
A total of 281 questionnaires was distributed and 221 replies (79%) were received. Of the responding hospitals, 97 (44%) reported having some form of acute pain service. Of these, 62 (28%) employed a specific pain nurse and 36 (16%) had specific “fixed” consultant sessions allocated to acute pain. Only 18 hospitals reported that additional funds had been provided for the purpose. In units where there was no acute pain service, the main reason (66/124; 53%) was financial. There was a regional variation in the availability of acute pain services (table).
Virtually every responding hospital used the newer analgesic techniques such as patient controlled analgesia or epidural opioid infusion to some extent, but in 42% of units (93) these techniques were used in less than 10% of patients after major surgery. Intermittent intramuscular injection of opioid remains the most commonly used technique in most hospitals, with 47% of units (104) using it in more than 50% of their patients.
More than four years after the publication of the report of the joint working party of the Royal College of Surgeons of England and the College of Anaesthetists on pain after surgery1 and despite reports of acute pain services in the United Kingdom,2 3 it is disappointing that less than half of the hospitals that responded in this survey had an acute pain service. However, the authors are aware that several hospitals have since developed such a service. Specific funding allocated to enable the establishment of an acute pain service was reported by only 18 hospitals and the relative rarity of specific “pain nurses” and dedicated medical sessions gives concern as to the permanence of these services. Pain, Discomfort and Palliative Care, a Welsh Health Planning Forum document, gives clear advice and targets for both the purchaser and the provider—including the establishment of an acute pain service in all hospitals in Wales by 1995.4 However, at the time of this survey, fewer than 50% of responding units in Wales had achieved this.
Although patient controlled analgesia and epidural opioid administration were available in most units, in many units such techniques were seldom used. Intermittent intramuscular injection of opioid is still widely used in a large number of hospitals. This may not necessarily be detrimental; good levels of analgesia can be achieved, as has been shown by Gould et al.5
It is to be hoped that an increasing number of hospitals will establish acute pain services. To this end, continued pressure should be placed on the purchaser to demand optimal acute pain management from their provider units—and be prepared to pay for it.
Funding This survey was undertaken as part of a national acute pain audit project funded by the Department of Health through the Royal College of Anaesthetists' Quality of Practice Committee.
Conflict of interest None.