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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 32  |  Issue : 3  |  Page : 163-166

Perception, knowledge, and attitudes of first-year postgraduates toward postoperative pain management: A questionnaire-based study


Department of Anaesthesiology, Government Medical College Miraj and Sangli Civil Hospital, Maharashtra, India

Date of Web Publication31-Dec-2018

Correspondence Address:
Dr. Pradnya M Bhalerao
1st Floor, Operation Theatre, Civil Hospital, Sangli, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpn.ijpn_31_18

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  Abstract 

Context: Inadequately controlled postoperative pain has undesirable physiological and psychological consequences. It increases postoperative morbidity, delays recovery, and hence causes a delayed return to normal daily living. Furthermore, the lack of adequate postoperative pain treatment may lead to persistent pain after surgery, which is often overlooked. Overall, inadequate pain management increases the use of health care resources and health care costs. Aim: To evaluate the knowledge and attitudes of first-year postgraduate students toward postoperative pain. Study Design: This questionnaire-based cross-sectional study was conducted on 42 first-year postgraduate students. Materials and Methods: A 20-point questionnaire was prepared based on the various aspects of postoperative pain services. The students were asked to provide their answers on a five-point Likert scale ranging from “strongly disagree” to “strongly agree.” The responses were kept anonymous, and the results were expressed in terms of percentage. Results: Almost 70% of students had a good knowledge of opioids, 52% strongly felt the need for a structured pain curriculum, 76% were well aware of nonpharmacological methods of pain relief, 48% agreed on the need for a pain physician, and 52% were aware of the advantage of postoperative analgesia. Conclusion: This pilot study helped us to evaluate the current understanding of our first-year postgraduate students and further created awareness on the importance of pain relief postoperatively.

Keywords: Knowledge, pain, postgraduates, postoperative


How to cite this article:
Adsule PB, Bhalerao PM, Dhumal PR. Perception, knowledge, and attitudes of first-year postgraduates toward postoperative pain management: A questionnaire-based study. Indian J Pain 2018;32:163-6

How to cite this URL:
Adsule PB, Bhalerao PM, Dhumal PR. Perception, knowledge, and attitudes of first-year postgraduates toward postoperative pain management: A questionnaire-based study. Indian J Pain [serial online] 2018 [cited 2019 Dec 7];32:163-6. Available from: http://www.indianjpain.org/text.asp?2018/32/3/163/249099


  Introduction Top


Pain is a predictable response to surgical intervention. It can affect hospital stay and cause both a personal suffering and social burden. Less than 30% of patients in India receive adequate pain management.[1] Undertreated pain leads to increased postoperative morbidity and mortality, prolonged hospital stay, and overcrowding of wards which consequently adversely affects the quality of health care.[2],[3],[4],[5],[6] Inadequate postoperative pain relief may result in clinical and psychological changes that may increase morbidity and mortality. This results in overcrowding of wards, increases the cost of treatment as a whole, and decreases the postoperative quality of life. Consequently adverse effects in the quality of health care are seen.[7]

Although various techniques of pain relief are available, adequate management of postoperative pain continues to be a major challenge. Similarly, the patient satisfaction toward pain management remains suboptimal.[8]

To improve the situation of the postoperative pain services in our hospital, we conducted this study to assess the knowledge, attitude, and perceptions of the first-year postgraduate students in various specialities regarding postoperative pain management. This group of doctors is the one that is in touch with the patient 24 h a day, and they need to be prepared to be acute pain physicians.

The primary objective was to assess the knowledge of the said doctors regarding the postoperative pain services using a questionnaire. The secondary objective was to create an awareness on the importance of pain relief in future consultants.


  Subjects and Methods Top


This questionnaire-based noninterventional prospective study was conducted in a tertiary care government hospital and medical college between May and September 2017. The questionnaire was answered by 42first-year postgraduates.

The questionnaire was prepared in accordance with the present trends in postoperative pain services in literature and the availability of resources in the government health setups. It included questions on attitude, perceptions, and beliefs regarding pain management services. A total of 20 questions were set, and students were asked to provide their answers on a five-point Likert scale ranging from “strongly disagree” to “strongly agree.” The responses were kept anonymous.

The questions were based on knowledge on opioids, teaching in the subject of perioperative pain, methods of pain relief available, availability of acute pain services, and pain assessment techniques.

The questionnaire was circulated among 42 first-year junior residents in the first month of their admission. They were asked to answer the questions in 30 min without consulting the text.

Statistical analysis

All the 42 postgraduates completed the questionnaire. The data were entered in an Excel sheet and analyzed. The results were recorded in terms of the percentage of student response for each item on the Likert scale.


  Results Top


Out of the 42 first-year postgraduate students, 52% students thought opioids should be easily available; 69% were well aware that opioids can cause addiction, and 59% knew that increased requirement of drug is a sign of addiction. Forty percent of the students were aware that opioids cause respiratory depression [Figure 1].
Figure 1: Knowledge regarding opioids

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Fifty-three percent agreed and 31% strongly agreed to the need for structured pain teaching for the undergraduates; 38% strongly agreed that there were barriers to cancer treatment [Figure 2].
Figure 2: Teaching regarding perioperative pain

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More than 50% had a good understanding of the methods of pain relief [Table 1].
Table 1: Methods of pain relief available

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That the patient had the right to expect pain relief was accepted by 71%. The need for a pain team on duty was agreed by 21% and strongly agreed by 24% [Figure 3].
Figure 3: Pain services

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Fifty percent knew the importance of pain relief and the presence of the World Health Organization (WHO) step ladder. More than half thought that there was a need for pain assessment tools [Table 2].
Table 2: Pain assessment

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  Discussion Top


Poor management of postoperative pain contributes to medical complications including pneumonia, deep vein thrombosis, depression, delayed wound healing, and chronic pain, and effectively delayed discharge and ambulation.[9],[10],[11] This can further lead to direct and indirect financial burden.[12] Hence all postoperative pain should be prevented or diagnosed and treated promptly.

However, despite the numerous guidelines on postoperative pain management, there is little improvement in the said subject.[13],[14],[15],[16],[17] Realizing the problems of unrelieved acute pain, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has recommended standards of pain management, especially with regard to assessment, monitoring, and treatment.[7] To counter this issue, acute pain services have been set up in various hospitals in the West.[18] The team providing these services includes doctors and paramedics. In our institute, the nursing staff and junior residents are in direct contact with the patient postoperatively over a longer period of time. They work as per the orders given by their senior doctors. However, lacunae in their knowledge regarding pain management do exist, and this part of patient care is often neglected.

The knowledge and attitudes of physicians on the subject of pain have also been explored, although perhaps to a lesser extent than nurses. Even fewer studies dealt with the role of pharmacists, particularly clinical pharmacists in pain management.[19]

Hence, we conducted this questionnaire-based study to know about the knowledge and attitudes of the first-year postgraduate students toward this subject.

Our students' knowledge on opioids had an accuracy of 40–50%. Sixty-two percent of students were aware of the addiction potential, and a similar percentage had an idea about the harmful respiratory depression [Figure 1]. Inaccessibility to opioids the world over is probably one of the prime reasons for this situation. Stressing on the safe use of opioids in current practice in the curriculum could help.

The requirement of specific teaching regarding acute pain services is another factor that was agreed upon. Only 65% knew that pain was the fifth vital sign [Figure 2].

With the concern for the undermanagement of pain, Dr. James Campbell in his 1995 presidential address to the American Pain Society presented the idea of evaluating pain as a vital sign.[20] By elevating it to the level of essential information, there is hope that proper evaluation and management would be made a routine practice.

A short questionnaire that is incorporated during the postoperative visit would help the patient self-evaluate the aspect of pain, and thus, treatment may become more regular and protocol based.

Sixty-nine percent agreed that psychiatric consultation can help in certain situations, and a fair number were aware of use of continuous infusion [Table 1].

Seventy-eight percent of our students were aware of the alternative methods of pain relief, and 70% thought that distraction in the form of music could reduce this pain [Table 1].

Sixty-two percent students stressed on the need for special pain services on campus and that it was the right of the patient to get pain relief postoperatively [Figure 3].

More than 60% students understood the need for pain assessment tool and pain relief for early ambulation post surgery [Table 2].

Many clinicians do not know what the appropriate response is because they lack adequate education in the approach, examination, and management of patients in pain. Pain education starting in medical school and through postgraduate training usually involves piecemeal incorporation of pain topics into existing curricula or clinical rotations, without devoted stand-alone class-time.[20] The net effect has been a serious deficit in clinical skills for the evaluation and management of the patient in pain.

Overall, the perception regarding postoperative pain management in our first-year postgraduates appears fair.

Studies have been conducted to know the knowledge and attitude of nurses toward pain. The respondents felt that infants perceive less pain than adults.[21] Restrain and distraction were used instead of scientific approaches.

Another study to assess the knowledge of nurses and physicians showed a better knowledge among trained anesthesiologists than physicians and surgeons.[22]

A literature review on the approaches of nurses and doctors toward pain showed that the knowledge, attitude, and perception was poor among both the groups.[23]

Postoperative pain has often been considered as a logical consequence of surgery that need not be tackled as a priority. This has led to a lack of standardized scientific approach.

Inputs by experts in the field of pain management have been taken by the WHO to formulate guidelines on all types of pain.[24]

We propose to have an improved set of protocols regarding management of pain postoperatively conducive to the availability of medications and techniques in our hospitals. Besides, an introduction to acute pain services can be incorporated in the internship training program.

The limitation of a questionnaire-based study is that the information gathered may be skewed. There may be a recall bias and a social desirability bias, which means the responders may give responses that appear more desirable socially.[25],[26] Besides, in our study group, though all had completed their internship, the students belonged to different institutions. All were first-year postgraduates, but now in different departments. As only a single center was considered, our sample size was small.


  Conclusion Top


Acute pain practice does exist in our institution but needs to be redefined. This pilot study helped us to evaluate the current understanding of our first-year postgraduate students and create awareness on the importance of pain relief postoperatively. Development of an in-house protocol and training of the acute pain service team would definitely help.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Khatib SK, Razvi SS, Kulkarni SS, Parab S. A multicentre survey of the current acute post-operative pain management practices in tertiary care teaching hospitals in Maharashtra. Indian J Anaesth 2017;61:215-24.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Macintyre PE, Walker S, Power I, Schug SA. Acute pain management: scientific evidence revisited. Br J Anaesth 2006;96:1-4.  Back to cited text no. 2
    
3.
Carr EC, Nicky Thomas V, Wilson-Barnet J. Patient experiences of anxiety, depression and acute pain after surgery: a longitudinal perspective. Int J Nurs Stud 2005;42:521-30.  Back to cited text no. 3
    
4.
Meissner W, Coluzzi F, Fletcher D, Huygen F, Morlion B, Neugebauer E, et al. Improving the management of post-operative acute pain: priorities for change. Curr Med Res Opin 2015;31:2131-43.  Back to cited text no. 4
    
5.
Iverson RE. Discussion: Clinical consequences of inadequate pain relief: barriers to optimal pain management. Plast Reconstr Surg 2014;134:22S-3S.  Back to cited text no. 5
    
6.
Masigati HG, Chilonga KS. Postoperative pain management outcomes among adults treated at a tertiary hospital in Moshi, Tanzania. Tanzan J Health Res 2014;16:47-53.  Back to cited text no. 6
    
7.
Harsoor S. Emerging concepts in post-operative pain management. Indian j Anaesth 2011;55:101-3.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Jain PN, Bakshi SG, Thota RS. Acute pain services in India: a glimpse of the current scenario. J Anaesthesiol Clin Pharmacol 2015;31:554-7.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Thomas MA. Pain management—the challenge. Ochsner J 2003;5:15-21.  Back to cited text no. 9
    
10.
Wells N, Pasero C, McCaffery M. Improving the quality of care through pain assessment and management. In: Hughes RG, editors. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, Maryland: Agency for Healthcare Research and Quality, 2008.  Back to cited text no. 10
    
11.
Meissner W, Coluzzi F, Fletcher D, Huygen F, Morlion B, Neugebauer E, et al. Improving the management of post-operative acute pain: priorities for change. Curr Med Res Opin 2015;31:2131-43.  Back to cited text no. 11
    
12.
Radnovich R, Chapman CR, Gudin JA, Panchal SJ, Webster LR, Pergolizzi JV Jr. Acute pain: effective management requires comprehensive assessment. Postgrad Med 2014;126:59-72.  Back to cited text no. 12
    
13.
Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 2005;24:466-77.  Back to cited text no. 13
    
14.
Gordon DB, Dahl JL, Miaskowski C, McCarberg B, Todd KH, Paice JA, et al. American pain society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force. Arch Intern Med 2005;165:1574-80.  Back to cited text no. 14
    
15.
Korean Knee Society. Guidelines for the management of postoperative pain after total knee arthroplasty. Knee Surg Relat Res 2012; 24:201-7.  Back to cited text no. 15
    
16.
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;97:534-40, table of contents.  Back to cited text no. 16
    
17.
Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a us national survey. Curr Med Res Opin 2014;30:149-60.  Back to cited text no. 17
    
18.
Werner MU, Søholm L, Rotbøll-Nielsen P, Kehlet H. Does an acute pain service improve postoperative outcome? Anesth Analg 2002;95:1361-72, table of contents.  Back to cited text no. 18
    
19.
Khawla N, Manal K, Basima A. Healthcare providers' knowledge and current practice of pain assessment and management: how much progress have we made? Pain Res Manag 2016;2016:1-7  Back to cited text no. 19
    
20.
Morone NE, Weiner DK. Pain as the fifth vital sign: exposing the vital need for pain education. Clin Ther 2013;35:1728-32.  Back to cited text no. 20
    
21.
Mathew PJ, Mathew JL, Singhi S. Knowledge, attitude and practice of paediatric critical care nurses towards pain: a survey in a developing country setting. J Postgrad Med 2011;57:196-200.  Back to cited text no. 21
    
22.
Zanolin ME, Visentin M, Trentin L, Saiani L, Brugnolli A, Grassi M. A questionnaire to evaluate the knowledge and attitudes of health care providers on pain. j Pain Symptom Manage 2007;33:727-36.  Back to cited text no. 22
    
23.
Ung A, Salamonson Y, Hu W, Gallego G. Assessing knowledge, perceptions and attitudes to pain management among medical and nursing students: a review of the literature. Br J Pain 2016;10:8-21.  Back to cited text no. 23
    
24.
World Health Organization (WHO). Normative guidelines on pain management: report of a Delphi Study to determine the need for guidelines and to identify the number and topics of guidelines that should be developed by WHO. Geneva: WHO; 2007.  Back to cited text no. 24
    
25.
Nasir D, Howard JE, Joshi GP, Hill GE. A survey of acute pain service structure and function in United States hospitals. Pain Res Treat 2011;2011:934932.  Back to cited text no. 25
    
26.
Nagi H. Acute pain services in the United Kingdom. Acute Pain 2004; 5:89-107.  Back to cited text no. 26
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

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