Page 4 Acute Pain Management
P. 4
FOREWORD
FOREWORD Less than a generation ago the prevalent attitude towards acute pain was widespread
acceptance as inevitable, and frequent indifference to its suboptimal management. Now,
proper pain management is understood to be a fundamental human right and integral to the
ethical, patient‐centred and cost‐effective practice of modern medicine. This progress is the
result of dedicated efforts by health care professionals worldwide, including many in Australia
and New Zealand who have contributed to past and present editions of Acute Pain: Scientific
Evidence. The consistently high standards of Acute Pain: Scientific Evidence have established it
as the foremost English‐language resource of its type worldwide. Changes between successive
editions reflect not simply accumulation of clinical evidence in this dynamic field, but also
advancing sophistication in methods of evidence synthesis and decision support. Chaired by
Associate Professor Pam Macintyre, assisted by many contributors and a distinguished
editorial subgroup of Professor Stephan Schug, Associate Professor David Scott, Dr Eric Visser
and Dr Suellen Walker, the working party responsible for the Third Edition of Acute Pain:
Scientific Evidence have continued to aggregate new clinical evidence and to expand the range
of topics. Even more, they have synthesised and presented the consolidated evidence in a
clear, user‐friendly fashion and highlighted instances where prior editions’ conclusions have
been altered by new findings.
The use of objective clinical evidence to provide a rational basis for practice is an old concept.
In the Old Testament, the Book of Daniel clearly recounts a prospective case‐controlled trial.
Socrates advocated clinical outcomes assessment as the basis for annual reappointment of
state physicians. Yet, aware that an evidence‐informed approach to patient care has recently
at times inappropriately been used as a rationale for restricting the range of therapeutic
options available to patients, the authors of the third edition counsel that ‘while knowledge of
current best evidence is important, it plays only a part in the management of acute pain for
any individual patient and more than evidence is needed if such treatment is to be effective.’
Personalised medicine and individualised care — in part necessitated by genetic differences in
drug metabolism and action, as discussed in the third edition — require such a balanced
approach. Cochrane himself voiced disdain for ‘the considerable pressure…to provide
physicians with a simple rule to tell them what it all meant’ [Cochrane AL: Effectiveness and
Efficiency: Random Reflections on Health Services. Cambridge (UK): Cambridge University
Press, 1989, p. 41].
The first edition of Acute Pain: Scientific Evidence (led by MJC) and its counterpart US federal
guideline over a decade ago (led by DBC) noted the clinical impression that undertreated acute
pain may have damaging long‐term consequences. Subsequent epidemiologic evidence now
affirms this clinical insight and indicates that for some patients debilitating persistent pain can
be averted by minimisation of acute pain after surgery or trauma. Even if it is not possible to
prevent the transition from acute to chronic pain in every case, early recognition and
treatment of incipient chronic pain by a vigilant healthcare system is necessary for cost‐
effective intervention. The National Pain Strategy document that underpins the 2010
Australian Pain Summit summarises the emerging literature on social, human and economic
costs of undertreated acute and chronic pain — establishing pain as a major disease burden
(www.painsummit.org.au) and proposing an integrated new framework for management of
acute, chronic and cancer pain. This historic summit also reiterated that apart from
considerations of reduced cost and increased efficiency, ethical medical practice mandates
prevention of unnecessary pain and suffering. Further the Summit Strategy draws heavily
iv Acute pain management: scientific evidence
