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Assessment and Management of Acute Pain in Adult Medical Inpatients

A Systematic Review

Evidence-based Synthesis Program

Investigators: Mark Helfand, MD, MPH and Michele Freeman, MPH.

Portland VA Healthcare System, Oregon Evidence-based Center
Washington (DC): Department of Veterans Affairs (US); 2008 Apr.
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Poor pain management in surgical settings is known to be associated with slower recovery, greater morbidity, longer lengths of stay, lower patient satisfaction, and higher costs of care, suggesting that optimal pain care in these settings is of utmost importance in promoting acute illness management, recovery, and adaptation. VA/DoD Clinical Practice Guidelines have been developed for the management of acute post-operative pain, although the basis for many of the recommendations was by expert consensus rather than empirical evidence.

The prevalence of pain on the inpatient medical ward is lower than that of a surgical service, but is still substantial. In one hospital survey, 43% of medical ward patients experienced pain, and 12% reported unbearable pain. There are currently no pain-relevant performance measures in place that can support efforts to enhance pain care in these settings, and research on pain management in nonsurgical, nonmalignant acute pain is sparse.


Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Portland Veterans Affairs Healthcare System, Oregon Evidence-based Practice Center, Portland, OR.

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