Characteristics of pain in hospitalized medical patients, surgical patients, and outpatients attending a pain management centre.

British Journal of Anaesthesia 2013;110(6):1017–1023.

Acute postoperative pain has been the subject of research for many years; even in the 1980s acute pain teams were established in the US and Europe to tackle this problem. The issue of non-surgical acute pain is less well dealt with. It is of concern that some acute postsurgical teams seem to have evolved to take on the management of medical patients with pain – often without the necessary experience or structure. 

This group have produced an important piece of work that should contribute to improved care for this group of patients by providing data about real life. They examined the characteristics and psychological impact of pain suffered by medical inpatients by comparing the pain experience of medical inpatients, surgical inpatients and patients attending a pain management centre. They also audited some aspects of the quality of pain scoring and prescribing. Medical inpatients with moderate or severe pain on a verbal rating scale were assessed using psychometric questionnaires. Comparator samples of surgical inpatients and patients attending the pain management centre were recruited. They demonstrated that the prevalence of significant pain did not differ between the medical (16.7%; n=37) and surgical group (19.9%; n=38). Chronic pain was common in both the medical (54%) and surgical group (50%). There were no differences in psychometric variables between the medical and surgical groups. It is notable that clinically significant anxiety and depression (HADS ≥11) were common in all groups (30-38%). There was less concordance between patient-reported pain scores and nurse-recorded pain scores in the medical group than the surgical group and analgesic prescribing differed between the two groups. This reflects, I am sure, the effect of educational initiatives in managing postsurgical pain. The pain management group differed from the inpatient groups, with higher levels of psychopathology and poorer coping. 

These findings provide some insight into the complex nature of pain in hospital inpatients, and may inform where limited resources should be utilised to provide greatest patient benefit. However there are more questions than answers.