Pain: The fifth vital sign

Posted on 15 March 2017

Mediclinic identifies pain as an indicator of patient vitality in all patients. Nurses officially monitor pain intensity alongside respiratory rate, blood pressure, pulse rate and temperature.

Dr Royden Donald, an anaesthesiologist and the clinical lead for Mediclinic Vergelegen’s pain service, says that effective pain management in hospitals is essential to improving patient outcomes and a crucial consideration in reducing recovery times. Patients who receive early or timeous pain management interventions show improved respiratory function and mobility. They also experience a reduced stress response leading to lower infection risk, accelerated wound healing and shorter hospital stays.

‘Persistent pain or a sudden increase in pain intensity despite appropriate intervention can be a warning sign that a patient is deteriorating,’ says Dr Donald. Mediclinic’s patient observation records and charts include routine pain intensity monitoring. Patients are asked to rate their pain experience on a scale of 0 to 10, with anything above 5 being cause for concern. Children and patients who are unable to speak are assessed using the Wong-Baker Faces Pain Scale: an illustrated succession of five smiley, ambivalent and sad faces that can be pointed at.

The International Association for the Study of Pain (IASP) has declared 2017 the Global Year Against Pain After Surgery. ‘Pain relief is a human right and every patient’s pain experience should be closely monitored and treated post-surgery,’ says Dr Donald. ‘But while we have the knowledge and tools to reduce pain and improve outcomes, compliance is often a problem.’

In a long-term audit conducted by Dr Donald he discovered that what appeared on paper to be low patient pain scores, were in fact an indication that healthcare workers and patients needed to be better educated around the importance of pain management. ‘Patients and personnel don’t always take the pain ratings seriously so they neglect the proper reporting and charting of pain. We’re on a massive drive to change this through training courses for nurses and patient information leaflets.’

Potential barriers to appropriate pain recording and management include dated mind set and lack of knowledge. ‘Painkillers have a disproportionately bad rap. The risk of addiction and adverse side effects is lower than the risk for developing chronic pain. The physiology of pain has been well researched and we can use specific pain medications to target pain receptors accordingly.’

As many as 30 to 40% of mastectomy patients suffer from chronic pain post-surgery. Hip replacements, knee replacements, hernia repairs, thoracotomies and total hysterectomies carry similar risks that can be circumvented by introducing pain medication prior to surgery to activate a patient’s inhibitory pain pathways.

‘I did not receive any specific lectures on the management of pain as an undergraduate. Only recently have some medical schools introduced a few hours of teaching on pain management. Generally speaking, medical professionals need to better educated about pain generation, interrogation and eradication.’