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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald


CiteScore 2018: 0.85

SCImago Journal Rank (SJR) 2018: 0.494
Source Normalized Impact per Paper (SNIP) 2018: 0.427

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1877-8879
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Volume 16, Issue 1

Issues

The changing face of acute pain services

Adriana Miclescu / Stephen Butler / Rolf Karlsten
Published Online: 2017-07-01 | DOI: https://doi.org/10.1016/j.sjpain.2017.04.072

Abstract

Background and Aims

Acute Pain Services have been implemented initially to treat inadequate postoperative pain. This study was undertaken to prospectively review the current challenges of the APS team in an academic hospital assessing the effects of its activity on both surgical and medical pain intensity. It also define the characteristics of the patients and the risk factors influencing the multiple visits from the APS team.

Method

This prospective cohort study was conducted at Uppsala University Hospital (a Swedish tertiary and quaternary care hospital) during one year. All the patients referred to the APS team were enrolled. A standardized data collection template of demographic data, medical history, pain diagnosis, associated diseases, duration of treatment, number of visits by the APS team and type of treatment was employed. The primary outcomes were pain scores before, after treatment and the number of follow-ups. The patients were visited by APS at regular intervals and divided by the number of visits by APS team into several groups: group 1 (one visit and up to 2 follow ups); group 2 (3 to 4 follow-ups); group 3 (5 to 9 follow-ups); group 4 (10 to 19 follow-ups); group 5 (>20 followups). The difference between groups were analyzed with ordinal logistic regression analyses.

Results

Patients (n = 730) (mean age 56±4, female 58%, men 42%) were distributed by service to medical (41%) and surgical (58%). Of these, 48% of patients reported a pain score of moderate to severe pain and 27% reported severe pain on the first assessment. On the last examination before discharge, they reported 25–30% less pain (P = 0.002). The median NRS (numerical rating scores) decreased significantly from 9.6 (95% confidence interval, 8.7–9.9) to 6.3 (6.1–7.4) for the severe pain (P < 0.0001), from 3.8 (3.2–4.3) to 2.4 (1.8–2.9) for the moderate pain. The odds ratio for frequent follow-ups of the patients between 18 and 85 years (n = 609) was 2.33 (95% CI: 1.35–4.02) if the patient had a history of chronic neuropathic pain, 1.80(1.25–2.60) in case the patient had a history of chronic nociceptive pain, 2.06(1.30–3.26) if he had mental diseases, and 3.35(2.21–5.08) if he had opioid dependency at the time of consultation from APS. Strong predictors of frequent visits included female gender (P = 0.04).

Conclusions

Beside the benefits of APS in reducing pain intensity, this study demonstrates that the focus of APS has been shifted from the traditional treatment of acute surgical pain to the clinical challenges of treating hospitalized patients with a high comorbidity of psychiatric diseases, opioid dependency and chronic pain.

Implications

The concept of an APS will ultimately be redefined according to the new clinical variables. In the light of the increasing number of patients with complex pain states and chronic pain, opioid dependency and psychiatric comorbidities it is mandatory that the interdisciplinary APS team should include other specialties besides the “classical interdisciplinary APS team”, as psychiatry, psychology, rehabilitation and physiotherapy with experience in treating chronic pain patients.

Keywords: Acute pains services; Predictors of uncontrolled pain; Complications of pain treatment

References

  • [1]

    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.PubMedCrossrefGoogle Scholar

  • [2]

    Rawal N. 10 years of acute pain services—Achievements and challenges. Reg Anesth Pain Med 1999;24:68–73.PubMedCrossrefGoogle Scholar

  • [3]

    Rowlingson JC, Rawal N. Postoperative pain guidelines-targeted to the site of surgery. Reg Anesth Pain Med 2003;28:265–7.PubMedGoogle Scholar

  • [4]

    Phillips DM. JCAHO pain management standards are unveiled, Joint Commission on Accreditation of Health Care Organizations. JAMA 2000;284:428–9.PubMedCrossrefGoogle Scholar

  • [5]

    Ready L. Development for an anesthesiology-based postoperative pain management service. Anesthesiology 1988;68:100–6.CrossrefPubMedGoogle Scholar

  • [6]

    Kim PS, Tobias M. Acute pain medicine: organizing an acute pain medicine service. Semin Anesthesia, Perioperative Med Pain 1999;18:157–65.CrossrefGoogle Scholar

  • [7]

    Lavelle EA, Cheney R, Lavelle WF. Mortality prediction in a vertebral compression fracture population: the ASA physical status score versus the Charlson Comorbidity Index. Int J Spine Surg 2015;9:63.Web of ScienceCrossrefGoogle Scholar

  • [8]

    Duncan F, Day R, Haigh C, Gill S, Nightingale J, O’Neill O, Counsell D. NIPPS Group. First steps toward understanding the variability in acute pain service provision and the quality of pain relief in everyday practice across the United Kingdom. Pain Med 2014;15:142–53.PubMedCrossrefGoogle Scholar

  • [9]

    Atkinson VJ, Almahdi B. A prospective audit project into the adequacy of pain assessment in the medical and surgical wards in a North London District General Hospital. Br J Pain 2014;8:78–83.CrossrefGoogle Scholar

  • [10]

    Miaskowski C, Crews J, Ready LB, Paul SM, Ginsberg B. Anesthesia-based pain services improve the quality of postoperative pain management. Pain 1999;80:23–9.PubMedCrossrefGoogle Scholar

  • [11]

    Stadler M, Schlander M, Braeckman M, Nguyen T, Boogaerts JG. A costutility and cost-effectiveness analysis of an acute pain service. J Clin Anesth 2004;16:159–67.CrossrefGoogle Scholar

  • [12]

    Tighe SQ, Bie JA, Nelson RA, Skues MA. The acute pain service: effective or expensive care? Anaesthesia 1998;53:397–403.PubMedCrossrefGoogle Scholar

  • [13]

    Rustøen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C. Prevalence and characteristics of chronic pain in the general Norwegian population. Eur J Pain 2004;8:555–65.CrossrefPubMedGoogle Scholar

  • [14]

    Bekhuis E, Boschloo L, Rosmalen JG, Schoevers RA. Differential associations of specific depressive and anxiety disorders with somatic symptoms. J Psych Res 2015;78:116–22.CrossrefGoogle Scholar

  • [15]

    Konnopka A, Margrit Löbner M, Luppa M, Heider D, Heinrich S, Riedel-Heller S, Jörg Meisel H, Günther L, Meixensberger J, König HH. Psychiatric comorbidity as predictor of costs in back pain patients undergoing disc surgery: a longitudinal observational study. BMC Musculoskelet Disord 2012;13:165.Web of ScienceCrossrefGoogle Scholar

  • [16]

    Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Int Med 2003;163:2433–45.CrossrefGoogle Scholar

  • [17]

    Dersh J, Gatchel RJ, Mayer T, Polatin P, Temple OR. Prevalence of psychiatric disorders in patients with chronic disabling occupational spinal pain disorders. Spine 2006;31:1156–62.CrossrefPubMedGoogle Scholar

  • [18]

    Blyth FM, March LM, Brnabic AJ, Cousins MJ. Chronic pain and frequent use of health care. Pain 2004;111:51–8.PubMedCrossrefGoogle Scholar

  • [19]

    Järvimäki V, Kautiainen H, Haanpää M, Koponen H, Spalding M, Alahuhta S, Vakkala M. Depressive symptoms are associated with poor outcome for lumbar spine surgery. Scand J Pain 2016;12:13–7.Web of SciencePubMedGoogle Scholar

  • [20]

    Curran GM, Sullivan G, Williams K, Han X, Allee E, Kotrla KJ. The association of psychiatric comorbidity and use of the emergency department among persons with substance use disorders: an observational cohort study. BMC Emerg Med 2008;8:17.PubMedCrossrefGoogle Scholar

  • [21]

    Zieger M, Schwarz R, König HH, Harter M, Riedel-Heller SG. Depression and anxiety in patients undergoing herniated disc surgery: relevant but under researched - a systematic review. Cent Eur Neurosurg 2010;71:26–34.CrossrefGoogle Scholar

  • [22]

    Demyttenaere K, Bruffaerts R, Lee S, Posada-Villa J, Kovess V, Angermeyer MC, Levinson D, de Girolamo G, Nakane H, Mneimneh Z, Lara C, de Graaf R, Scott KM, Gureje O, Stein DJ, Haro JM, Bromet EJ, Kessler RC, Alonso J, Von Korff M. Mental disorders among persons with chronic back or neck pain: results from the World Mental Health Surveys. Pain 2007;129: 332–42.Web of SciencePubMedCrossrefGoogle Scholar

  • [23]

    Walker EA, Katon W, Hansom J, Harrop-Griffiths J, Holm L, Jones ML, Hicock LR, Russo J. Psychiatric diagnoses and sexual victimization in women with chronic pelvic pain. Psychosomatics 1995;36:531–40.PubMedCrossrefGoogle Scholar

  • [24]

    Huxtable CA, Roberts LJ, Somogyi A, Macintyre PE. Acute pain management in opioid-tolerant patients: a growing challenge. Anaesth Intensive Care 2011;39:804–23.PubMedGoogle Scholar

  • [25]

    Rapp SE, Ready LB, Nessly ML. Acute pain management in patients with prior opioid consumption: a case-controlled retrospective review. Pain 1995;61:195–201.CrossrefPubMedGoogle Scholar

  • [26]

    Compton P, Charuvastra VC, Kintaudi K, Ling W. Pain responses in methadone-maintained opioid abusers. JPSM 2000;20:237–45.Google Scholar

  • [27]

    Bäckström R, Rawal N. Acute Pain Service – what it is, why it is and what is next? Eur J Pain 2008;S2:40–3.Google Scholar

  • [28]

    Rawal N, Berggren L. Organization of acute pain services: a low cost model. Pain 1994;57:117–23.PubMedCrossrefGoogle Scholar

  • [29]

    Breivik H. Persistent postsurgical pain (PPP) reduced by high quality management of acute pain extended to sub-acute pain at home. Scand J Pain 2014;5:237–9.Google Scholar

  • [30]

    Tiipana E, Hamunen K, Helskanen T, Nieminen T, Kalso E, Kontinen VK. New approach for treatment of prolonged postoperative pain: APS Out-Patient Clinic. Scand J Pain 2016;12:19–24.PubMedWeb of ScienceGoogle Scholar

  • [31]

    Jensen TS, Stubhaug A, Breivik H. Important development: Extended Acute Pain Service for patients at high risk of chronic pain after surgery. Scand J Pain 2016;12:58–9.Web of SciencePubMedGoogle Scholar

About the article

Multidisciplinary Pain Center, ing 79, Uppsala University Hospital, Sjukhusvägen, 75185 Uppsala, Sweden.


Received: 2017-01-13

Revised: 2017-04-14

Accepted: 2017-04-30

Published Online: 2017-07-01

Published in Print: 2017-07-01


Conflict of interest: None declared.


Citation Information: Scandinavian Journal of Pain, Volume 16, Issue 1, Pages 204–210, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2017.04.072.

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