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Editorial

Acute pain services: transition from the Middle Ages to the 21st century

Aken, H. Van; Buerkle, H.

Author Information
European Journal of Anaesthesiology: May 1998 - Volume 15 - Issue 3 - p 253-254

In this issue of the European Journal of Anaesthesiology, Rawal and co-workers are presenting data from a survey performed in 1993 about the acute pain services (APS) in Europe [1]. The investigators have revealed a negative picture in European contemporary acute pain management during 1993. Despite the evidence that APS result in an improved quality of patient care, [2] only one third of the selected hospitals provided an organized APS and even in those hospitals less than 65% kept strict protocols or guidelines for pain management. In addition, the limited quality assurance measurements made in acute pain management demonstrate another major drawback in acute pain therapy during the early 1990s. The first official guidelines for the management of severe pain, including acute post-operative pain, were published in Australia in 1988 [3] followed by the United Kingdom in 1990 [4] and the United States in 1992 [5]. These recommendations, in addition to other guidelines, included the need for acute pain teams together with audit and quality assurance. However, there is a clear discrepancy between the strong agreement among experts of the need for APS and its implementation into clinical practice as shown by this current survey. Insufficient funding was reported by the survey as one of the foremost reasons for the lack of APS at their separate institutions. The cost of such equipment including patient controlled analgesia (PCA) devices and the cost of trained APS members needs to be considered in terms of the clear-cut benefits of reduced mortality, morbidity or hospital stay. We have recently demonstrated, in our institution, that these result from the introduction of APS [6]. The high rate of dissatisfaction regarding individual APS indicated in Rawal's study clearly reflects the physician's position. If there is no improvement in acute pain therapy within the peri-operative setting, this negative perception could also be shared more and more by individual patients. In the competition for patients between hospitals, those providing an optimal APS [7] will be at an advantage. A number of guidelines have been published with regard to the techniques used for post-operative pain control [8]. Several different models for the optimal organization of APS have been described [9,10]. Future studies comparing the different approaches will be needed to achieve an evidence base for APS. The role of anaesthesiologists, with their particular professional skills, are essential to provide leadership for the integration of acute pain management in their institutions.

The results of this study are both, discouraging on one side, but also stimulating on the other side, if the anaesthesiologists in Europe will take adequate action implied by this report. We are encouraging the authors to perform a follow-up study and hopefully a positive trend towards modern acute pain management will be demonstrated.

H. Van Aken

H. Buerkle

Anästhesiologie und operative; Intensivemedizin, der Westfälischen; Wilhelms-Universität Münster, Germany

References

1 Rawal N, Allvin R, EuroPain Acute Pain Working Party. Acute pain services in Europe: a 17 nation survey of 105 hospitals. Eur J Anaesthesiol 1998; 15: 354-363.
2 Wulf H, Neugebauer E. Guidelines for postoperative pain therapy. Curr Opin Anaesthesiol 1997; 10: 380-385.
3 Management of Severe Pain. National Health and Medical Research Council Commonwealth Australia, 1998.
4 The Royal College of Surgeons of England and the College of Anaesthetists. Report of the Working Party on Pain after Surgery. London: HMSO, 1990.
5 US Department of Health and Human Services. Clinical Practice Guideline. Acute Pain Management: Operative or Medical Procedures and Trauma. Rockville, Maryland: Agency for Health Care and Policy and Research, 1992.
6 Brodner G, Pogatzki E, Buerkle H, Mertes N, Nottberg H, Van Aken H. Anesthesia and analgesia: influence of postoperative patient controlled epidural analgesia combined with early extubation and forced mobilization on outcome in patients undergoing abdomino-thoracic esophageal resection. Anesth Analg 1998; 86: 228-234.
7 Rauck RL. Cost-effectiveness and cost/benefit ratio of acute pain management. Reg Anesth 1996; 21 (Suppl. 6): 139-143.
8 American Society of Anesthesiologists Task Force on Pain Management, Acute Pain Services. Practice guidelines for acute pain management in the perioperative setting. Anesthesiology 1995; 82: 1071-1081.
9 Rawal N, Berggren L. Organization of acute pain services: a low cost model. Pain 1994; 57: 117-123.
10 Warfield CA, Kahn CH. Acute pain management. Programs in US hospitals and experience and attitudes among US adults. Anesthesiology 1995; 83: 1090-1094.
© 1998 European Society of Anaesthesiology