Clinical Review

Fortnightly review: Treating acute pain in hospital

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7093.1531 (Published 24 May 1997) Cite this as: BMJ 1997;314:1531
  1. Henry McQuaya, clinical reader in pain relief,
  2. Andrew Moore, consultant biochemista,
  3. Douglas Justins, consultant in pain managementb
  1. a Pain Relief Unit, Churchill Hospital, Oxford OX3 7LJ
  2. b Department of Anaesthesia, St Thomas's Hospital, London SE1 7EH
  1. Correspondence to: Dr Justins

    Introduction

    In treating acute pain, tradition and ill informed prejudice sometimes hold sway over evidence and common sense. In this review we concentrate on simple, clinically appropriate, and evidence based treatments.

    FIG 1

    Factors influencing the pain reported by patients

    Methods

    Whenever possible we based our recommendations on systematic reviews of randomised trials. A citation database of systematic reviews of pain relief can be found at http://www.jr2.ox.ac.uk/Bandolier/painres/MApain.html. 1 We chose reviews for their relevance and quality. Poor quality reviews are significantly more likely to make positive conclusions.1 We collected over 12 000 randomised trials of analgesic interventions from 1950 onwards2; these are available on the Cochrane database. We used trials from this database when there was no relevant systematic review.

    Summary points

    Opt for safety and simplicity

    Measure and record pain regularly–be proactive

    Choose evidence based interventions

    Trust patients and tailor treatment to their individual needs and allow them to have control

    Choose appropriate drug, route, and mode of delivery

    Educate staff and patients

    What is pain?

    The neurophysiology of acute pain may be complex, with sensory, affective, cognitive, and behavioural dimensions intertwined (fig 1). Although pain is influenced by all the factors in figure 1), the subjective measurement of pain has proved to be robust. At its simplest the patient reports pain, and this report is the yardstick against which doctors measure the effects of treatment. The message is “believe the patient.” Doctors cannot measure pain objectively, so the management of pain in patients who cannot report pain, such as babies and those who are unconscious, may pose problems.

    Effective pain management is fundamental to the quality of care. We believe that good control of pain also speeds recovery, but there is still no compelling evidence that this is so. Advantage can be shown with proxy measures such as mobility or coughing, but evidence …

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