Page 130 Guide to Pain Management in Low-Resource Settings

118 O. Aisuodionoe-Shadrach

What specifi c roles should the doctors and • Don’t believe that the ability to tolerate pain is a
nurses play in ensuring that patients in this measure of “manhood.”
scenario are pain-free? • Th e truth is that pain is not meant to be tolerated.
Th e clinicians should proceed to quantify the patient’s • It may not be practical to expect patients in the
degree of pain using the following methodical ap- acute trauma/preoperative setting to be absolute-
proaches: ly pain-free.
• A brief oral pain history documented at the time • However, pain can be reduced to tolerable levels
of admission. by using widely available techniques.
• A measurement of the patient’s pain using a self- • Develop an algorithm for the management of
reporting instrument, e.g., VAS or VRS. pain in the acute trauma/perioperative setting, as
• Th e use of behavioral observation as an adjunct shown in Fig. 1.
to the self-report instruments.
• Monitoring of the patient’s vital signs (although References
this is not a specifi c or sensitive test for pain).
Th ese procedures should be repeated at peri- [1] Aisuodionoe-Shadrach IO, Olapade-Olaopa EO, Soyanwo OA. Preop-
erative analgesia in emergency surgical care in Ibadan. Tropical Doctor
odic intervals by the attending health professional with 2006;36:35–6.
a view to assessing the effi cacy of the analgesic regimen. [2] Reuben SS, Ekman EF. Th e eff ect of initiating a preventive multi-
modal analgesic regimen on long-term patient outcomes for outpa-
Further measures include ensuring good patient posi- tient anterior cruciate ligament reconstruction surgery. Anesth Analg
2007;105:228–32.
tioning with the use of pillows and blankets in addition [3] Reuben SS, Buvanendran A. Preventing the development of chronic
to the application of hot or cold compresses as needed. pain after orthopedic surgery with preventive multimodal analgesic
techniques. J Bone Joint Surg 2007;89:1343–58.

Pearls of wisdom Websites

• Avoid misconceptions and recognize culturally
Pain: current understanding of assessment, management, and treatments.
determined beliefs about pain. (2001). National Pharmaceutical Council and Joint Commission on Accredi-
tation of Healthcare Organizations.
• Always remember that pain cannot be ignored. Available at: http://www.npcnow.org/resources/PDFs/painmonograph.pdf