2. PAIN
•Pain is the most
common presenting
complaint
•Acute pain is
associated with
distinct disease or
tissue injury
•It is usually limited in
duration
•Initiate a host of
physiological
changes summarized
as “stress response”.
3. EXAMPLES OF ACUTE PAIN
• Fractures and
dislocation
• Flail chest
• Burn injury
• Acute pancreatitis or
cholecystitis
• Acute renal colic
• Acute myocardial
infarction
4. EXAMPLES OF ACUTE PAIN
• Fractures and
dislocation
• Flail chest
• Burn injury
• Acute pancreatitis or
cholecystitis
• Acute renal colic
• Acute myocardial
infarction
• LABOUR PAIN
• POST OPERATIVE
PAIN
5. MAJORITY OF POST OPERATIVE PAIN
IS NOT ADEQUATELY MANAGED
“A visit to most postoperative wards will show you the
time-honoured ritual of inadequate postoperative pain
management.
Harmer, M. 1991: Anaesthesia 46, 167-8.
6. MAJORITY OF POST OPERATIVE PAIN
IS NOT ADEQUATELY MANAGED
•As many as 75% of patients undergoing
the 73 million surgical procedures
performed annually in the United States
experience postoperative pain
• Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain
experience: results from a national survey suggest postoperative pain
continues to be undermanaged. Anesth Analg. 2003;97:534-540.
7. ACUTE POST OPERATIVE PAIN
MANAGEMENT- A TRADITIONAL WAY
SURGEON
SURGEON
MEDICAL OFFICER
MEDICAL OFFICER
HOUSE OFFICERS
HOUSE OFFICERS
WARD NURSES
WARD NURSES
8. ACUTE POST OPERATIVE PAIN
MANAGEMENT- A TRADITIONAL WAY
SURGEON
SURGEON
MEDICAL OFFICER
MEDICAL OFFICER
HOUSE OFFICERS
HOUSE OFFICERS
WARD NURSES
WARD NURSES
i.m Pethidine 50 mg, 6 hourly PRN…
9. ACUTE POST OPERATIVE PAIN
MANAGEMENT- A TRADITIONAL WAY
SURGEON
SURGEON
MEDICAL OFFICER
MEDICAL OFFICER
HOUSE OFFICERS
HOUSE OFFICERS
WARD NURSES
WARD NURSES
i.m Pethidine 50 mg, 6 hourly PRN…
i.m Voltaren 50 mg tds
i.m Tramal 50 mg tds
10. Congress declared the years
of 2000 to 2010 as the
Decade of Pain Control and
Decade of Pain Control and
Research.
Research.
The Physiology and Processing of Pain: A Review
American Association of Critical-Care Nurses
Volume 16(3), July/September 2005, p 277–290
Renn, Cynthia L. RN, PhD, ACNP; Dorsey, Susan G. RN, PhD
11. USA 2001
USA 2001
Australia, Europe 2002, 2003
Australia, Europe 2002, 2003
Singapore 2004, 2005
Singapore 2004, 2005
Malaysia
Malaysia
Hospital Selayang 2006 (Pilot)
Hospital Selayang 2006 (Pilot)
Ministry of Health 2008 - 2010
Ministry of Health 2008 - 2010
12. Objective:
Types of pain.
Types of pain.
Assessment of pain.
Assessment of pain.
Use pain assessment tools effectively
Use pain assessment tools effectively
Assess patients’ pain level
Assess patients’ pain level
Identify and carry out nursing intervention
Identify and carry out nursing intervention
appropriately.
appropriately.
Involve patients in their pain management.
Involve patients in their pain management.
Involve parents in the care of their children’s pain
Involve parents in the care of their children’s pain
13. Benefits of Pain as 5th
Vital sign
i. Provide holistic patient care
Provide holistic patient care
ii.
ii. To evaluate pain level
To evaluate pain level
iii.
iii. To give effective treatment
To give effective treatment
iv.
iv. To promote early ambulation
To promote early ambulation
v.
v. Reduce post-operative complications
Reduce post-operative complications
vi.
vi. Reduce length of stay
Reduce length of stay
vii.
vii. Reduce health care costs
Reduce health care costs
viii.
viii. Promote nurse-patient interaction
Promote nurse-patient interaction
ix.
ix. Promote client satisfaction – reduce
Promote client satisfaction – reduce
complaints
complaints
x. Improve quality of life
x. Improve quality of life
14. Ministry of Health, Malaysia
Ministry of Health, Malaysia
Pilot project (2011)
Pilot project (2011)
Hospital Selayang
Hospital Selayang
Hospital Ipoh
Hospital Ipoh
Hospital Putrajaya
Hospital Putrajaya
Expansion of project (2013)
Expansion of project (2013)
Hospital Tengku Ampuan Rahimah, Kelang
Hospital Tengku Ampuan Rahimah, Kelang
Hospital Tuanku Jaafar, Seremban
Hospital Tuanku Jaafar, Seremban
Hospital Melaka
Hospital Melaka
Hospital Sultan Ismail, Johor Bahru
Hospital Sultan Ismail, Johor Bahru
Hospital Raja Perempuan Zainab II, Kota Bharu
Hospital Raja Perempuan Zainab II, Kota Bharu
Pain Free Hospital
15. Multimodal multidisciplinary pain
Multimodal multidisciplinary pain
management
management
Minimal invasive surgery (MIS)
Minimal invasive surgery (MIS)
Pain management drugs and techniques
Pain management drugs and techniques
Physiotherapy
Physiotherapy
Traditional and complementary medicine
Traditional and complementary medicine
Non-pharmacological measures
Non-pharmacological measures
Monitoring of vital signs
Monitoring of vital signs
Pain Free Hospital
16. Pain Free Hospital
Concepts:
Concepts:
Concepts:
Concepts:
Pain Free Hospital
Anaesthesia
Anaesthesia
&
&
Analgesia
Analgesia
Traditional &
Traditional &
Complimentary
Complimentary
Medicine
Medicine
Modern surgical
Modern surgical
techniques
techniques
Pain
Free
Hospital
17.
Aim:
Aim:
To make patient comfortable
To make patient comfortable
Pain score 0 – 3/10
Pain score 0 – 3/10
Pain Free Hospital
23. ATTRIBUTING FACTORS TOWARD
POORLY-MANAGED ACUTE PAIN
1. IGNORANCE OF THE STAFF & DOCTORS
Lack of awareness & understanding
about the importance of good post-
operative pain relief
• Inadequate education on pain
management
2. OVER WORKED
• Staff & doctors attending other duties and
neglect the pain suffered by the patients
24. ATTRIBUTING FACTORS TOWARD POORLY-MANAGED ACUTE PAIN
3. WRONG TRADITIONAL PERCEPTION ABOUT PAIN
•`It is normal to have pain’
• `Child never have pain’
4. MISCONCEPTION ABOUT THE USE OF OPIOIDS
• Fear of overtreating/ overdose/ respiratory
depression
• Fear of causing addiction
• PRN interpretation
5. MINIMAL AVAILABLE THERAPEUTIC OPTIONS
• Limited choice of technique
• Limited choice of drugs
25. MANAGEMENT OF ACUTE PAIN
• Effective pain management is fundamental to the quality
of care.
• A good pain management hastens patient recovery and
reduces morbidity, particularly to the cardiovascular and
respiratory systems.
• The key to successful pain management is education &
training to all staff.
26. MANAGEMENT OF ACUTE PAIN
• The concept of a team of health care providers
dedicated to acute pain management has gained
popularity worldwide.
• In our multidiscipline pain service model, an Acute
Pain Service (APS) has been established using the
approach of combining the best aspects of
specialist-based and nurse-directed services.
27. MANAGEMENT OF ACUTE PAIN
This model provides an effective pain management
strategy at a lower cost. It has been used
successfully in Orebro Medical Center Hospital in
Sweden.
N Rawal: Annals, Academy of Medicine, Singapore. Vol. 23 No. 6 Nov
(Suppl) 1994
28. MANAGEMENT OF ACUTE PAIN
• Overall responsibility, including policy procedure,
education & therapeutic expertise, is provided &
coordinated by the anaesthesiologist in
collaboration with:
• Anaesthetic medical officers
• Acute Pain Nurse
• Nursing staff
• Surgical specialist/ medical officers.
29. ACUTE PAIN SERVICE (APS)
HPUNISZA
•Started our services in 2024
Properly organized Acute Pain Management
Objectives & Strategies
Existence of APS Team
Resource allocation
Regular monitoring
30. ORGANIZATION OF SERVICES
Pain Management
Pain Management
Services
Services
Acute Pain Service
Acute Pain Service
(APS)
(APS)
Obstetric
Obstetric
Analgesia Service
Analgesia Service
Chronic Pain
Chronic Pain
Management
Management
31. THE ROLE OF ACUTE PAIN SERVICE
IN HPUNISZA
1. To improve the quality of acute pain management
especially for post-op and trauma patients.
2. To improve understanding and perception of staff
and doctors about pain so that they are able to
manage it confidently and effectively.
3. To develop and implement standard protocols on
pain management and its monitoring.
32. THE ROLE OF ACUTE PAIN SERVICE
IN HPUNISZA
4. To provide regular training to staff, doctors and
houseman about acute pain management.
5. To conduct audit activities on acute pain service:
• To study the effectiveness of each technique
• To identify problems and complications
• To collect data on workload and technique
used
6. To establish `APS Team’ and `APS Nurse’
34. THE AMERICAN SOCIETY OF
ANAESTHESIOLOGISTS’ TASK FORCE ON PAIN
MANAGEMENT RECOMMENDS:
• Proactive individualized planning for patient
care;
• Staff training for the effective, safe use of the
available options;
• Information for and the education of patients;
35. THE AMERICAN SOCIETY OF
ANAESTHESIOLOGISTS’ TASK FORCE ON PAIN
MANAGEMENT RECOMMENDS:
• The assessment and documentation of therapeutic
efficacy and side-effects;
• Protocols (for drug ordering, administration and
discontinuation, and for the transfer of
responsibility);
36. THE AMERICAN SOCIETY OF
ANAESTHESIOLOGISTS’ TASK FORCE ON PAIN
MANAGEMENT RECOMMENDS:
• The availability of appropriate therapeutic
techniques (PCA, patient-controlled epidural
analgesia[PCEA], regional anaesthesia or a
multimodal approach);
• The 24-hour availability of a responsible
anaesthesiologist, who should also be familiar
with paediatric, geriatric and ambulatory
surgery pain management.
37. SUMMARY
• Majority of patients get
inadequate post operative
analgesia.
• Adequate management of
post operative pain require
appropriate education to
the nursing and medical
staff.
• Establishment of well
organized Acute Pain
Service is pivotal in
successful management of
acute pain.
![THE AMERICAN SOCIETY OF
ANAESTHESIOLOGISTS’ TASK FORCE ON PAIN
MANAGEMENT RECOMMENDS:
• The availability of appropriate therapeutic
techniques (PCA, patient-controlled epidural
analgesia[PCEA], regional anaesthesia or a
multimodal approach);
• The 24-hour availability of a responsible
anaesthesiologist, who should also be familiar
with paediatric, geriatric and ambulatory
surgery pain management.](https://image.slidesharecdn.com/apstalk-250617005022-7cb1bfe7/85/APS-TALK-ppt-an-introductory-course-to-pain-service-for-non-anesthesiologist-36-320.jpg)
