Many patients experience significant post-surgical pain after hospital discharge despite being provided with analgesics, new Australian research suggests.
Almost half (47%) of the 169 patients surveyed following surgery at the Royal Hobart Hospital, Tasmania, experienced moderate-to-severe pain in the week following discharge from hospital, a study has found
More than 95% of patients were provided with analgesics and 90% received advice about managing their pain after surgery, but two-thirds were underusing analgesics compared with guideline recommendations.
Opioids were used by 60% of patients, paracetamol by 79% and NSAIDs were used by 27% of patients in the week after discharge.
The most common reasons for underuse of analgesics were fear of overuse, not understanding directions — such as which drugs to use and how often — and trying to tolerate pain without analgesics.
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The study authors, from the University of Tasmania, said their findings showed the influence that good information about pain management had on a patient’s treatment outcome.
They suggested it was time to explore different approaches in providing advice to patients.
“It appears that post-discharge pain is often being undermanaged, by both healthcare professionals and patients, and is an area that requires increased attention to improve patient outcomes,” they concluded.
Dr Milana Votrubec, a GP and pain consultant in Sydney, said patients needed to be reassured that it was okay to take medication, and discharging doctors should keep analgesic advice simple, using diagrams or pictures in their information.
“GPs can only help if they see the patient. These days, unfortunately, surgery happens, and the patient comes out of hospital with their packet of pills and not much else,” she said.
Another problem was that patients were being discharged with a small supply of short-acting opioids, she added.
“So either the patient saves them up and only uses them when the pain is really bad or they have already become used to using quite an amount of opioids,” she said.
“A lot of us out here in GP land find ourselves faced with patients who’ve gone on postoperatively with pain that becomes entrenched, or you get a cohort of patients who are already well and truly used to taking pain medications and continue to take them long after they should be because stopping gives them symptoms of withdrawal,” Dr Votrubec said.
Understanding pain in less than five minutes
Journal of Clinical Pharmacy and Therapeutics 2017; online.