APPROPRIATE DOSAGE THAT FOLLOWS THE INDIVIDUAL COURSE OF PAIN


Pain varies considerably between individuals, even after the same surgical procedure.1 The following table gives an overview of factors that can influence the perception of pain:2

 

Influences Examples
Culture Language/words, religious attitude towards pain, social appraisal of stoicism, accepted attitude (of patient) to pain.
Demographics Gender, age, lifestyle, bodyweight
Psychosocial Gender of observer(s), status and environment, personality, mood, sleep pattern, mental illness.
Clinical Patient’s knowledge of diagnosis, disease, treatment outcome, type of operative procedure, degree of trauma.


It is important that a treatment regime follows the course of the patient’s pain, in order to avoid the risk of under- or over-dosing. One reason is that adverse events are dose-dependent, as in the case of opioids.3 Using the right amount of analgesic treatment can minimize adverse events or analgesic gaps. To achieve this, the right treatment regime should be also taken into account. To give an example: a study has shown that continuous infusion leads to a 24% higher opioid intake with no improvement in pain scores. In comparison, patient-controlled analgesia has been shown to support the objective of lowering opioid uptake.4

 

Opioid intake over 48-hour treatment period


Furthermore, treatment should allow the titration of analgesia to the changing characteristics of pain over a short period. Patient-controlled analgesia allows tailoring of treatment to the needs and responses of individual patients.5 This is an advantage, since there is a variation in patients’ individual responses to medications and in the therapies used to treat post-operative pain.6 Taking into account a study that states that 61% of nurses believe that post-operative pain routines are too general,7 there probably is a need in the future for a change from current post-operative pain treatment routines to treatment regimes that consider the individual course of pain of the patient.

Ability of treatments to follow individual course of pain

 

References

1 Allegri M, de Gregori M, Niebel T, et al. Minerva Anestesiol. 2010; 76: 937-44.
2 Belfer I. Scientifica. 2013; Article ID 415279: 19 pages.
3 Zhao SZ et al. Dose-response relationship between opioid use and adverse effects after ambulatory surgery. J Pain Symptom Manage. 2004; 28: 35-46.
4 Stamer UM et al. Postoperative analgesia with tramadol and metamizol continual infusion versus patient controlled analgesia (article in German). Anaesthesist. 2003;52:33-41.
5 Lien C and Youngwerth J. Patient-controlled analgesia. Hosp Med Clin. 2012; e386-e403.
6 Manworren RCB et al. Multimodal pain management and the future of a personalized medicine approach to pain. AORN. 2015; 101: 307-18.
7 Stomberg MW et al. The role of a nurse anesthetist in the planning of postoperative pain management. AANA Journal. 2003; 71: 197-202.
8 Grass JA et al. Patient-controlled analgesia. Anesth Analg. 2005; 101: S44-S61.