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3. PROVISION OF SAFE AND EFFECTIVE ACUTE
PAIN MANAGEMENT
The safe and effective management of acute pain requires the appropriate education of
medical, nursing and allied health staff and patients, and attention to the organisational
aspects involved in the delivery of pain relief. These include appropriate guidelines for drug
prescription, monitoring of patients and recognition and treatment of any adverse effects of
pain relief, and in some situations, the provision of an acute pain service (APS). It is recognised
that the need for and complexity of these requirements will vary according to the setting in
which acute pain relief is delivered (eg hospital, general practice).
Successful acute pain management also requires close liaison with all personnel involved in
the care of the patient including anaesthetists, pain specialists, surgeons, physicians, palliative
care clinicians, general practitioners, specialists in addiction medicine, nurses, physiotherapists
and psychologists.
Equally, if not more importantly, patient participation (ie including the patient as part of the
treating and decision‐making team, taking into account their values, concerns and
expectations) is required if each patient is to get the best treatment. Patients should be CHAPTER 3
provided with accurate and up‐to‐date information, including risks and likely outcomes of
treatment, and be partners in discussions relating to choice of care. They should also have
access to other evidence‐informed information that explains current treatment
recommendations as well as have access to treatment consistent with those
recommendations (Duckett, 2009).
3.1 EDUCATION
3.1.1 Patients
Patients and their carers who learn about assessment of pain as well as risks and side effects
of treatment, and who are made aware that they should communicate both effectiveness (or
otherwise) and the onset of any side effects, will have some control over the delivery and
success of their pain relief, regardless of the technique used. There should also be information
on treatment options, goals, and likely benefits and probability of success (Macintyre & Schug,
2007; Counsell et al, 2008).
Patient or carer education may take a number of forms — the most common methods are the
use of booklets or short videos and specialist one‐on‐one education. A review of the evidence
for any benefit from preoperative education or the best educational technique concluded that
it is varied and inconsistent (Oshodi, 2007).
Patients may find that preoperative education is helpful (Shuldham, 1999) and it may increase
patient or carer knowledge about pain and positive attitudes towards pain relief (Chambers et
al, 1997 Level II; Greenberg et al, 1999 Level II; Watkins, 2001 Level II; Cheung et al, 2007 Level II).
Patient knowledge about pain relief was lower in those given verbal (non‐standardised)
information at the time of seeing the anaesthetist prior to surgery compared with those given
written information before they attended the interview; more patients in the latter group felt
that the information was thorough and understandable and helped in discussion about
postoperative pain management options (Binhas et al, 2008 Level III‐2).
Acute pain management: scientific evidence 45
