Chapter 37. Pain Management

Erica Brownfield, MD Emory University School of Medicine Approximately 23 million people undergo surgery each year in the United States. Despite pharmacologic interventions, at least 40-50% of postoperative patients report inadequate pain relief. In addition, the practice of withholding analgesics due to fear of masking symptomatology and delaying diagnosis is still widespread in many emergency rooms and acute care settings. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Agency for Health Care Policy and Research (AHCPR) have established guidelines for the appropriate assessment and management of pain in general and postoperatively. Yet efforts to educate clinicians as to appropriate pain management, particularly in emergency departments (ED) and following surgery, have lagged behind the available evidence. We have taken the point of view that untreated pain represents a patient safety problem. This chapter reviews pain management techniques and interventions in 4 domains: use of analgesics in patients with acute abdominal pain, the use of acute pain services, prophylactic antiemetics during patient-controlled analgesia therapy, and non-pharmacologic interventions for postoperative pain.