Postoperative Pain is an Under Appreciated, Under Treated Problem in the Uni... (concern. In partnership with Ortho-M...)

Postoperative Pain is an Under Appreciated, Under Treated Problem in the United States

Date:10/3/2007

concern."

In partnership with Ortho-McNeil, Inc., ASPAN convened an expert panel of specialists in the field of acute pain management, who prepared the report following a thorough assessment of the current state of postoperative pain management and those trends that may lead to increased safety and better patient care in the future.

Designed to provide the most up-to-date information about the state of postoperative pain management in the United States, the ASPAN report identifies those factors that contribute to inadequate pain relief after surgery: under-estimation of postoperative pain by physicians and nurses, deliberate under-treatment due to clinicians' concerns about the potential for adverse events, and a limited understanding among health care professionals about therapeutic strategies for treating postoperative pain, which usually involve the administration of opioids using intravenous patient-controlled analgesia (IV PCA). Although IV PCA is supported by favorable efficacy and patient preference data, this system has been associated with needle-related injuries and IV-related phlebitis, accidental overmedication, narcotic-induced respiratory depression, and other adverse events.

To address these challenges in using IV PCA, the report describes a number of promising technologies using different analgesic agents and methods to deliver patient-controlled analgesia, including the introduction of a "smart pump" and the use of regional neural blockades combined with oral opioids in patients recovering from orthopedic surgery. Additionally, in development is the first needle-free, patient-controlled iontophoretic transdermal system and patient-controlled intranasal analgesia (PCINA), whereby opioids, in either a dry powder form or in a saline solution, are delivered using a syringe, nasal spray, dropper or nebulized inhaler.

Taking Steps to Address Postoperative Pain Management

While advances in technology are important, the ASPAN
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