Acute pain: a challenging problem

Garcia, João Batista Santos

doi:10.1590/S1806-00132013000300001

EDITORIAL

In this edition of Revista Dor several articles approach the issue of acute pain, discussing specific aspects of its presentation, as well as its assessment in special populations, as ICU children, or even drug therapy techniques for postoperative pain. They call our attention to the problem of this type of pain in our country and to the concern of our services with its impact on individuals. Acute pain is also seen as a complaint which is both difficult to control and common in family medicine, sports medicine and in general medical practice.

Although there were significant advances in pain research in the last decades, insufficient pain control remains the rule and not the exception. Studies show that 30% to 40% of patients discharged after outpatient procedures have moderate to severe pain during the first 24 to 48 hours¹. Pain decreases with time, but can be severe enough to interfere with sleep and daily tasks. Besides that, post-op pain is the most prevalent factor for delays in hospital discharges, as well as the main cause for medical calls after discharges and the most prevalent reason for hospital readmissions^2,3. Issues like nausea, vomiting, fatigue and pain are the most common reasons to delay discharge as well as the most common ones for readmitting patients to the hospitall^1,2.

Severe post-op pain causes extreme discomfort and distress, being associated with sleep disorders, which lead to fatigue. This situation may last for some days, preventing patients to return to working activities, thus generating economic impact in their lives. Another aspect to be considered is the negative impact of post - op pain and other forms of acute pain on several organs and organ systems, such as heart and lungs⁴.

Post-op pain may persist for a long time and be considered as chronic post-op pain syndrome, which is now being recognized as a significant problem that must be diagnosed and fought against. This situation is most commonly seen in limb amputation surgeries, thoracotomies, mastectomies and inguinal hernias. The incidence of post-op chronic pain in outpatient procedures, such as inguinal hernia repair, may be more than 50%⁵.

Pain complaints are the most frequent reason for emergency ward consultations, representing more than 70% of all cases seen⁶. A large study, carried out in the United States, showed an average pain score of 8 in the numeric scale in patients seen at the Emergency Room. Around 41% of patients reported no relief or worsening of pain after visiting the ER, and almost three fourths of them reported moderate to severe pain at discharge⁶.

We hope that papers published in this edition may somehow contribute to decrease the current situation of acute pain underassessment and undertreatment.

João Batista Santos Garcia

Revista Dor Editor

REFERENCES

1. Schug SA, Chong C. Pain management after ambulatory surgery. Curr Opin Anaesthesiol. 2009;22(6):738-43.
2. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97(2):534:40.
3. Segerdahl M, Warrén-Stomberg M, Rawal N, Brattwall M, Jakobsson J. Clinical practices and routines for day surgery in Sweden: results from a nation-wide survey. Acta Anaesthesiol Scand. 2008;52(1):117-24.
4. Wu CL, Berenholtz SM, Pronovost PJ, Fleisher LA. Systematic review and analysis of postdischarge symptoms after outpatient surgery. Anesthesiolology. 2002;96(4):994-1003.
5. Perkins FM, Gopal A. Postsurgical chronic pain: a model for investigation the origins of chronic pain. Tech Reg Anesth Pain Manag. 2003;7(2):122-6.
6. Todd KH, Ducharme J, Choiniere M, Crandall CS, Fosnocht DE, Homel P, Tanabe P; PEMI Study Group. Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study. J Pain. 2007;8(6):460-6.