Pain management is critical to healing. Without proper guidelines for treating pain, patients will experience delayed recovery, a longer hospital stay, readmission, and may eventually suffer from chronic pain.
“It is not only an ethical problem but also a medical and economic problem,” said Dr. Antonio Montero, head, Department of Anesthesiology and Pain Unit, University Hospital Amau de Vilanova, Lerida, Spain. “Acute pain is the most common symptom experienced by surgical patients, and has historically been poorly evaluated and often underrated.”
Montero was one of the guest speakers during the Philippine College of Surgeons (PCS) 74th Annual PCS Congress, presented in collaboration with Italian pharmaceutical company A. Menarini (A. Menarini Phils. Inc.) and the Menarini Academy.
“Whenever you perform a surgery you make a cut—that is a definite source of pain,” said Dr. Alejandro Dizon, president, Philippine College of Surgeons. “Part of standard pain management is addressing that even before the patient wakes up.”
Montero said there are 400 million surgeries performed worldwide each year. In Asia, there are 50 million procedures each year, with 30 percent of the operated patients suffering intense pain in the first 24 hours.
There are guidelines for treating pain, Montero said. While doctors and nurses must record and measure pain regularly in order to evaluate the need for a better treatment option, they should always opt for a safer and simpler treatment, use appropriate drugs, and address all phases of the surgical period.
“The challenge is to provide patients with effective and safe treatments in a cost-effective manner, while ensuring that they are satisfied with their experience,” Montero said.
Achieving patient satisfaction is an important goal for health systems and healthcare professionals. A delay in effective acute pain treatment will make the patient anxious and increase morbidity, Montero said.
Patients must also work with the surgeon, said Dizon. It is important to sit down with the doctors to discuss options and outcomes.
“There are more options now available. The patient must always be involved in the decision-making process. Ultimately, it’s going to be the patient’s decision. What doctors can do is provide clarity,” Dizon said. “Gone are the days when patients entrust everything to the doctor.”
But in moderate to severe pain, it can be difficult to obtain effective analgesia with a single drug. Montero said in such cases, doctors must use a multimodal approach, such as the combination of a nonsteroidal anti-inflammatory drug (NSAID) and opioids to achieve better control of pain after surgery.
“We want the patient to go back to a normal life as soon as possible. We don’t want the patient to be complaining, that’s why it is important to have a protocol,” Montero said.
The PCS is the leading organization of board-certified Filipino surgeons in the country who are strongly committed to excellence and ethical practice. Currently, there are 10 surgical specialty and 12 surgical subspecialty societies under the PCS.