Page 20 Acute Pain Management
P. 20






Adverse
physiological
and
psychological
effects
of
acute
pain

1.

 Recognition
of
the
importance
of
postoperative
rehabilitation
including
pharmacological,

physical,
psychological
and
nutritional
components
has
led
to
enhanced
recovery
(N)

(Level
II).

 Acute
pain
and
injury
of
various
types
are
inevitably
interrelated
and
if
severe
and

prolonged,
the
injury
response
becomes
counterproductive
and
can
have
adverse
effects

on
outcome
(U).

Pharmacogenomics
and
acute
pain

SUMMARY
  Genetic
polymorphisms
explain
the
wide
inter‐individual
variability
in
plasma

1.

CYP2D6
polymorphisms
affect
plasma
concentrations
of
active
metabolites
of
codeine

and
tramadol
(N)
(Level
II).


concentrations
of
a
given
dose
of
methadone
(N).


2. ASSESSMENT AND MEASUREMENT OF PAIN AND ITS TREATMENT

Measurement

1.
 Regular
assessment
of
pain
leads
to
improved
acute
pain
management
(U)
(Level
III‐3).


2.
 There
is
good
correlation
between
the
visual
analogue
and
numerical
rating
scales
(U)

(Level
III‐2).


 Self‐reporting
of
pain
should
be
used
whenever
appropriate
as
pain
is
by
definition
a

subjective
experience
(U).

 The
pain
measurement
tool
chosen
should
be
appropriate
to
the
individual
patient;

developmental,
cognitive,
emotional,
language
and
cultural
factors
should
be

considered
(U).

 Scoring
should
incorporate
different
components
of
pain
including
the
functional

capacity
of
the
patient.
In
the
postoperative
patient
this
should
include
static
(rest)
and

dynamic
(eg
pain
on
sitting,
coughing)
pain
(U).

 Uncontrolled
or
unexpected
pain
requires
a
reassessment
of
the
diagnosis
and

consideration
of
alternative
causes
for
the
pain
(eg
new
surgical/
medical
diagnosis,

neuropathic
pain)
(U).



Outcome
measures
in
acute
pain
management

 Multiple
outcome
measures
are
required
to
adequately
capture
the
complexity
of
the

pain
experience
and
how
it
may
be
modified
by
pain
management
interventions
(U).

3. PROVISION OF SAFE AND EFFECTIVE ACUTE PAIN MANAGEMENT

Education

1.
 Preoperative
education
improves
patient
or
carer
knowledge
of
pain
and
encourages
a

more
positive
attitude
towards
pain
relief
(U)
(Level
II).


2.
 Video
education
of
patients
with
a
whiplash
injury
reduces
the
incidence
of
persistent

pain
(N)
(Level
II).

3.
 Written
information
given
to
patients
prior
to
seeing
an
anaesthetist
is
better
than
verbal

information
given
at
the
time
of
the
interview
(N)
(Level
III‐2).


xx
 Acute
Pain
Management:
Scientific
Evidence

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