The acute pain service: Present and future role

摘要

Acute pain services were introduced more than 20 years ago as an organizational attempt to meet shortcomings in postoperative pain management. The acute pain service concept received immediate and strong support from a large number of medical and health-care organizations around the world. Literature reviews indicate that 30-70% of North-American and European hospitals, depending on size and academic affiliation, have an acute pain service. The advantages of a multiprofessional team approach in postoperative pain management seem obvious, but has the acute pain service demonstrated its value? Recent reviews indicate disappointingly that inadequate pain relief continues to be a clinically significant and major problem. Though implementation of an acute pain service has been associated with a significant improvement in patients' postoperative pain ratings and satisfaction scores, there are no conclusive data available in regard to side effects, adverse events or postoperative morbidity. Future strategies should focus on outcome analyses of pain management, including estimates of cost-effectiveness, and the acute pain service should be an integrated part of clinical pathways directed at early postoperative rehabilitation leading to an improvement in postoperative outcome. The lack of relevant outcome data, however, may pose a threat in an increasingly cost-conscious public health-care sector.