PAIN AFTER SURGERY FEARED AND UNDERTREATED

NEW YORK (Reuters Health) - Pain remains a focal issue for patients
entering surgery, with almost 60% listing pain as their greatest
concern--above the desire to get better or fully recover, researchers
reported here last week.

Those fears may be well-grounded. Overall, 47% of surgery patients
experience moderate pain, 21% experience severe pain, and 18% experience
extreme pain, reported Dr. Jeffrey Apfelbaum, professor of Anesthesiology
and Critical Care at the University of Chicago in Illinois. Apfelbaum spoke
here on Friday at a meeting of pain management experts sponsored by the
Pharmacia Corporation.

``Surgical pain post-operatively is not inevitable because we have ways to
treat pain that are very effective, but the reality is that most patients
are not cognizant of that,'' said Apfelbaum.

He surveyed 250 patients who had surgery at hospitals, clinics, doctor's
offices or ambulatory centers within the past 5 years. Among the sample,
one-third were male and two-thirds were female, with ages ranging between
18 and 55.

According to the study, about 50% of patients said they were satisfied with
the pain medication they received before leaving the hospital or clinic and
40% were very satisfied with their pain management after going home.

In an interview with Reuters Health, Apfelbaum stressed that the problem of
unnecessary pain among patients recovering from surgery is due, in large
part, to a lack of monitoring by health care professionals and a lack of
communication between doctor and patient.

Hopefully, new standards from the Joint Commission Standards on Pain
Management (JCSPM) will alleviate the problem, he said.

The standards, which are set to take effect on January 1, 2001, are geared
towards all accredited US hospitals. They suggest that pain be considered
the ``5th vital sign,'' after temperature, pulse, respiration and blood
pressure. Focusing on the importance of relieving pain may increase
doctors' awareness of the issue and help to relieve patient fears.

``Everybody does have a right to be treated for pain,'' said Susie McBeth,
the associate director in the Department of Standards for the JCSPM. ``And
I think it is essential to get everybody in the health care community up to
speed because not everybody knows how to do an appropriate assessment of
pain and manage that pain over a continuum of care.''

McBeth said that studies such as Apfelbaum's reinforce the need for a new
approach to managing pain, and that the new standards are needed to
instigate this change.