Year : 2019 | Volume
: 33 | Issue : 1 | Page : 1--2
Pain management in the eyes of a surgeon: A reality check in combating the epidemic of persistent post operative pain
Vice Chancellor, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
Prof. Tariq Mansoor
M.S, F.I.C.S, Vice Chancellor, Aligarh Muslim University, Aligarh, Uttar Pradesh
|How to cite this article:|
Mansoor T. Pain management in the eyes of a surgeon: A reality check in combating the epidemic of persistent post operative pain.Indian J Pain 2019;33:1-2
|How to cite this URL:|
Mansoor T. Pain management in the eyes of a surgeon: A reality check in combating the epidemic of persistent post operative pain. Indian J Pain [serial online] 2019 [cited 2019 Jul 16 ];33:1-2
Available from: http://www.indianjpain.org/text.asp?2019/33/1/1/255709
Less than a decade ago, the well-accepted attitude of a surgeon toward acute postoperative pain was that it is an evitable part of any surgical procedure, and hence their indifference toward optimal or suboptimal management was an issue not worth discussing. In the developing nations, even today, this pain remains underassessed and undertreated by the surgical specialty. In a few countries, limited availability of resources along with the confused and mixed priorities together results in partial or inadequate relief from postoperative pain.
At the other end of the spectrum, even in the developed nations, with adequate resources and the well-established pain management services, postoperative pain relief remains more of a dream than reality.
It is also observed that even those with life-limiting diseases have to bear moderate-to-severe postoperative pain in the remaining few days of their life. Among various factors, inadequacy of resources, sociocultural practices and the psychosocial issues in the preoperative period has an extensive impact on the management of postoperative pain.
Adequacy in management would thus involve ramifications of physiological, cognitive, and socioeconomic consequences for not only the patients and their families, but also the society as a whole.
Seeing through the surgeon's spectacles, almost all of us are aware of the postoperative pain which does not get relieved by 3-, 6-, or 9-month follow-up; i.e. patients experiencing chronic postsurgical pain.
Various factors need to be taken care of to alleviate management inadequacy and thus chronicity in postoperative pain. These include:
Proper documentation and protocols for pain assessment and management in the postoperative periodAvailability of various analgesics and devices such as a patient-controlled analgesic device and intravenous and epidural infusion pumps as a part of multimodal analgesic protocolThis is also a universal truth that the insult to the tissues and nerves is an important factor for persistent postoperative pain. Use of minimally invasive and nerve-sparing techniques could help reduce this complicationThe pain education programs need to be aimed at creating an interdisciplinary pain management service.
The International Association for Study of Pain, in an attempt to optimize acute postoperative pain management, had officially launched the Global Year Against Acute Pain on October 18, 2010. The initiative was to improve the basic understanding of acute pain among the masses and also highlighted the challenges that the anesthesiologists and surgeons face while managing acute postoperative pain. It was also an important milestone after which the inability to alleviate acute postoperative pain was recorded as an unethical surgical practice, an obvious violation of human rights, and this violation was designated as a professional misconduct and professional incompetency.
Simple surgeon-delivered local anesthetic techniques such as wound infiltration, periperitoneal/intraperitoneal administration, and local infiltration analgesia also play a significant role if religiously practiced, keeping in view the patient profile. The current guidelines seem to appear as “one size fits all,” i.e., a single common pain relief protocol for all postoperative patients. The approach needs refinement to one that is individualized as per the patient's need. Pain characteristics such as type, location, intensity, and duration vary considerably after different surgical procedures.
Procedure-specific postoperative pain management recommendations taking into consideration the anesthetic and surgical techniques and the risk–benefit aspects are to be brought to common practice. Upgrading the role of surgical ward nurses and integrating with enhanced recovery after surgery protocols with regular audits is the actual need of time.
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