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Improving Outcomes in Acute Pain Management: Optimizing Patient Selection

Authors: Donald R. Taylor, MDFaculty and Disclosures



"Pain elicited by the injury of body tissues and activation of nociceptive transducers at the site of local tissue damage... In general, the state of acute pain lasts for a relatively limited time and generally remits when the underlying pathology resolves.[1]"

Acute pain can be caused by a wide variety of medical, surgical, and traumatic events, and it is one of the primary reasons patients seek medical attention. Although it is a normal protective response to a harmful or potentially damaging stimulus, once acute pain has alerted us to the danger of further injury or has caused us to seek medical care, it no longer serves a useful purpose. At this point, it should be treated aggressively. Likewise, although the nature, intensity, and progression of pain may be useful in the diagnosis of certain disorders, this should rarely be an excuse for allowing the patient to suffer severe pain for an extended period of time.[2]

Severe pain causes adverse physiological effects. This has been long recognized in the management of acute myocardial infarction in which pain control is used to help lower the heart rate and blood pressure, thus reducing myocardial oxygen consumption in an attempt to limit infarct size. Poorly controlled acute pain also can produce long-term adverse effects; postoperative and severely ill patients with poorly controlled pain may be at high risk for developing chronic pain.[3,4] In the postoperative setting, good pain control results in fewer cardiopulmonary complications, less mortality, and lower costs.[3] For cancer patients with poorly controlled breakthrough pain, the cost of pain-related care has been found to be 5-6 times higher than in those without breakthrough pain.[4] Thus, although humanitarian reasons alone should prompt us to strive for optimal pain control, there are also medical and financial reasons to provide the best pain control possible.

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