The changing face of the acute pain
2016 (English)Conference paper, Poster (Other academic) [Artistic work]
Aims: To distinguishthe risk factors associated with uncontrolled and problematic pain by prospectively assessing the current acute pain service (APS) activity in an academic hospital and theeffects of this activity on both surgical and medical pain intensity.
Method: This prospective cohort study was conducted at Uppsala University Hospital (a Swedish tertiary and quaternary care hospital) during one year. All the patients referred to APS team were enrolled. A standardized data collection template of demographic data, medical history, pain diagnosis, associated diseases, duration of treatment, number of visits by the APS team and type of treatment was employed. The primary outcomes were pain scores before and after treatment. The patients were visited by APS at regular intervals and divided after the number of visits by APS team in several groups: group 1 (one visit and upto 2 follow ups); group 2 (3 to 4 follow-ups); group 3(5 to 10times follow-ups); group 4 (10 to 20 follow-ups); group 5 more than 20 follow–ups. The groups and the difference between groups were analyzed.
Results: Patients (n=730) (mean age 56±4, female 58%, men 42%) were distributed by service to medical (41%) and surgical (58%). Of these, 48% of patients reported a pain score of moderate to severe pain and 27% reported severe pain on the first assessment. On the last examination before discharge, they reported 25–30% less pain (P=0.002). The median NRS (numerical rating scores) decreased significantly from 9.6 (95% confidence interval, 3.4–5.3) to 6.3 (1.0–2.0) for the severe pain (p<0.0001), from 3.8 (3.1–3.8) to 2.4 (2.2–2.4) for the mild pain. Respiratory depression related to pain treatment was reported in 1.6% patients. The APS treated cognitive deficits related to pain treatment, in 30% of the patients, recognized and treated opioid overdose in 14%. The patients who required more than 5 visits by the APS(280 patients representing 38% of all the patients) demonstrated an increased prevalence of psychiatric diseases (from 10% in group 1 to 42% in group 5), opioid dependency (13% in group 1 to 100% in group 5) and chronic painresulted from both nociceptive (gradually increasing from 38% in group 1 to 85% in group 5) and neuropathic pain (from 13 % in group 1 increasing to 35% in group 5). The diagnoses encountered in the patients with frequent visits by the APS team were cancer related pain (17%), endometriosis (9%), reoperation(12%), burn injury(5%).
Conclusions: Beside the benefits of APS in reducing of pain intensity, and in treating analgesia side effects, this study demonstrates the uncertain role of APS in the treatment of acute pain. The focus of APS has been shifted from the traditional treatment of acute surgical pain to the clinical challenges of treating hospitalized patients who suffered adverse effects from pain treatment and have a high of comorbidities aspsychiatric diseases, opioid dependency and non-surgical chronic pain.
Place, publisher, year, edition, pages
Anesthesiology and Intensive Care
Research subject Anaesthesiology and Intensive Care
IdentifiersURN: urn:nbn:se:uu:diva-280190OAI: oai:DiVA.org:uu-280190DiVA: diva2:910316
8Th World Congress of Institute of Pain New York 20Th-23 Th May , 2016