Pattern of pain management practices of Filipino surgeons

Among all the fields of specialization in medicine, the surgeons probably encounter the highest number of pain patients, aside from 'causing' many painful conditions due to surgical procedures. It was widely presumed that surgeons in general do not pay much attention to pain management of their patients, often passing on the responsibility to other specialists.

A survey was conducted among general surgeons from all the regions in the Philippines. There were 167 respondents of 200 questionnaires sent. An 18-item, multiple-choice questionnaire was developed to assess their prevailing pain management practices preoperatively, postoperatively and when the patients are recovering, as well as their preferences in medications.

The majority of the respondents (58%) claim that they personally manage their patients' postoperative pain. Almost half use a combination of a nonsteroidal anti-inflammatory drug (NSAID) and a weak opioid, and only 13% use a combination of a strong opioid and an NSAID. Only 17% of the respondents start oral medications in the recovery room. The majority (90%) claim that they personally attend to their patients' pain in the wards. Almost all the respondents (98.8%) started oral medications as soon as possible. Only 20% of the respondents always use the Visual Analog Scale in pain assessment. The majority of the respondents (55%) have no narcotic license (S2).

Although the majority of the respondents claim to be involved in the management of perioperative pain of their patients, an objective assessment of the patients' pain is not usually done. The use of opioids alone or in combination is still low among Filipino surgeons; the main reason could be the regulatory provisions of the government on opioid use.