Clinical management of acute pain

The clinical management of acute pain has been impeded by traditions and misconceptions which have resulted in suboptimal application to the patient of the currently available methods of pain control. The search for new drugs and exotic ways to deliver them has further obscured many of the basic principles which should guide management. Standard regimens fail because of the wide, unpredictable variability in pain intensity, patient characteristics, and pharmacological responses. Treatment needs to be individualized for each patient. Unrelieved acute pain produces psychological, physiological and socioeconomic consequences. Pre-emptive analgesia may damp down the development of both immediate and long-term pain following surgery and adequate psychological preparation can improve coping abilities. The delivery of opioid analgesics can be improved using patient controlled analgesia or spinal administration in some cases. Regional analgesia, often using simple techniques, can produce excellent pain relief. Overall management and staff education should be delegated to an acute pain service.