South African Acute Pain Guidelines
Acute pain management – Foreword
I prefaced the first edition of the South African acute pain guidelines by stating that “acute pain management is not a luxury, it is a human right!” Six years have passed and the statement is still pertinent.
The World Federation of Societies of Anaesthesiologists and the International Association for the Study of Pain have both identified the fact that pain is badly managed in all parts of the world, but that attention needs to be given to pain management in developing countries. It has become evident that acute pain management must be the starting point for educational initiatives. Chronic pain can only be addressed when the management of acute pain is effected.
Anaesthesiologists predominantly treat acute postoperative pain. Records of their success have been documented, but it has been demonstrated in only a few studies that alleviating this form of pain is effective. The classic Apfelbaum study of 2003 revealed that in the period 1995–2003, very little progress was made in managing pain. Approximately 80% of all surgical patients experienced moderate to extreme pain following their surgery. Reports from the recent European PAIN OUT Symposium 2014 were also not encouraging as it was revealed that 40% of patients experienced severe postoperative pain, and almost 50% of patients wished that they had received better pain therapy. Is this acceptable today? I believe not. This fact merely serves to demonstrate that the need identified by the two world bodies exists! We need to focus our attention on the management of acute pain, as the effective treatment of acute pain must become a fundamental component of quality patient care.
Is the relief of acute pain the only outcome that we need to assess when managing postoperative patients? The very simple answer to this question is: “No”. Unrelieved pain has other consequences besides patient satisfaction. Adverse physiological and psychological effects may result from unrelieved severe acute pain. The effective treatment of postoperative pain may reduce the incidence of postoperative morbidity and facilitate earlier discharge from hospital. Furthermore, the successful treatment of postoperative pain reduces the incidence of chronic pain. It can be concluded that there are physiological, psychological and economic reasons to ensure that patients receive effective acute pain therapy.
If acute pain management is a priority, then it follows that educational initiatives must form part of the overall plan. This guideline forms an integral part of the initiative as it serves as a reference to all practitioners who manage acute pain. The guideline not only provides factual medical information, but also deals with non-medical issues, such as patient education. The authors focus on how analgesia, its role in recovery and rehabilitation, and other available nonpharmacological options can improve acute pain management.
As stated in the first edition of the guideline, this document must be considered an aid to any healthcare professional managing acute pain, rather than a “recommended” regimen. The individual practitioner must evaluate the patient and adapt any of the suggestions according to the medical condition or American Society of Anesthesiologists status of that particular patient.
I concluded the first foreword by stating, “It is hoped that by using the information provided in this publication there will be meaningful bene t for both the medical professional and the patient”. Six years later, I can proudly state that the use of this guideline will provide meaningful bene t to both medical practitioners and patients.
Dr Milton Raff
Chairperson: World Federation of Societies of Anaesthesiologists Pain Relief Committee