Page 94 Acute Pain Management

Others have suggested that in general, structured preoperative patient education may
improve patient outcome including pain relief (Devine, 1992 Level III‐2; Guruge & Sidani, 2002
Level III‐2; Giraudet‐Le Quintrec et al, 2003 Level II). Compared with routine and also structured
patient information, education using a video about patient‐controlled analgesia (PCA)
improved both patient knowledge and pain relief (Chen et al, 2005 Level III‐2).
Some studies have shown no effect of education on postoperative pain or analgesic
requirements (Griffin et al, 1998 Level II; Greenberg et al, 1999 Level II), including PCA (Chumbley et
al, 2004 Level III‐1), although there may be an increase in patient satisfaction (Knoerl et al, 1999
Level III‐1; Watkins, 2001 Level II; Sjoling et al, 2003 Level III‐2) and less preoperative anxiety (Sjoling
et al, 2003 Level III‐2).
In studies looking at specific types of surgery, there was no evidence that preoperative patient
education has any effect on postoperative pain after:
• hip or knee replacement (McDonald et al, 2004 Level I);
• cardiac surgery in adults (Shuldham et al, 2002 Level II; Watt‐Watson et al, 2004 Level II) or
children (Huth et al, 2003 Level II);
CHAPTER 3 • laparoscopic cholecystectomy (Blay & Donoghue, 2005 Level II);
• gynaecological surgery (Lam et al, 2001 Level II);

• gastric banding (Horchner & Tuinebreijer, 1999 Level III‐1); or
• spinal fusion in children and adolescents (Kotzer et al, 1998 Level III‐3).
A systematic review of studies, looking at the benefits or otherwise of preoperative education
for orthopaedic patients, highlighted the difficulties of comparing studies of variable
methodological quality; while some individual studies may show benefits of preoperative
education, the lack of a consistent pattern with regard to effect was confirmed (Johansson et al,
2005 Level III‐2).
The effect of patient education has also been studied in patients with non‐surgical pain.
Antenatal teaching about postnatal nipple pain and trauma resulted in reduced nipple pain
and improved breastfeeding (Duffy et al, 1997 Level II). After an acute whiplash injury, fewer
patients shown an educational video in addition to ‘usual care’ had persistent pain at 3 and
6 months; opioid use and use of health care resources was also lower (Oliveira et al, 2006
Level II). Education and counseling regarding pain management, physical activity, and exercise
reduced the number of days off work in patients with acute low back pain (Godges et al, 2008
Level III‐1). In a study of patients with pain presenting to an emergency department, those
shown educational videos or printed brochures had greater decreases in self‐reported pain
than those given no education (Marco et al, 2006 Level III‐1). Compared with verbal advice,
provision of an information sheet to patients with acute chest pain reduced anxiety and
depression and improved mental health and perception of general health, but did not alter
patient satisfaction with health care or other outcomes such as lifestyle changes or
presentation with further chest pain (Arnold et al, 2009 Level II).

3.1.2 Staff

Appropriate education of medical and nursing staff is essential if more sophisticated forms of
analgesia (eg PCA or epidural analgesia) are to be managed safely and effectively, and if better
results are to be gained from conventional methods of pain relief (Macintyre & Schug, 2007).
Medical and nursing staff education may take a number of forms — the evidence for any
benefit or the best educational technique is varied and inconsistent. Education may also
include the provision of guidelines.

46 Acute Pain Management: Scientific Evidence