Acute Pain: Effective Management Requires Comprehensive Assessment

• Published in: Postgraduate medicine Vol. 126; no. 4; pp. 59 - 72
• Main Authors: Radnovich, Richard, Chapman, C. Richard, Gudin, Jeffrey A., Panchal, Sunil J., Webster, Lynn R., Pergolizzi, Joseph V.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01-07-2014
• Subjects: acute pain; Acute Pain - diagnosis; Acute Pain - drug therapy; Acute Pain - prevention & control; Acute Pain - psychology; Algorithms; Analgesics - administration & dosage; Analgesics, Opioid - administration & dosage; Humans; opioid-related disorders; Pain Measurement; pain perception; Pain, Postoperative - drug therapy
• ISSN: 0032-5481; 1941-9260
• DOI: 10.3810/pgm.2014.07.2784

Pain is among the most common reasons that patients seek medical care, and inadequate assessment may result in suboptimal management. Acute pain in response to trauma or surgery can be complex, variable, and dynamic, but its assessment is often simplistic and brief. One-dimensional rating scale measures of pain severity facilitate rapid evaluation and often form the basis of treatment algorithms. However, additional features of pain should inform the selection of a treatment regimen, and can include pain qualities, duration, impact on functional capabilities, and underlying cause. Patient age, sex, psychosocial features, and comorbid conditions are also important features to consider. Use of a multidimensional tool is recommended for assessing many of these features if time permits. Additionally, clinicians often fail to recognize or consider the potentially detrimental long-term effects of acute pain. As the United States continues to experience a prescription drug crisis, a "universal precautions" approach including abuse risk assessment and abuse deterrence strategies should be implemented for patients receiving opioids. Increased efforts and research are necessary to enhance the utility of available acute pain assessment tools. Developing more comprehensive tools for patient assessment is the first step in achieving the ultimate goal of effective acute pain management. The objectives of this review are to summarize issues regarding the complexity of acute pain and to provide suggestions for its evaluation.