Assessment and management of acute pain in adult medical inpatients

A systematic review

Mark Helfand, Michele Freeman

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Objective: To review the literature addressing effective care for acute pain in inpatients on medical wards. Methods: We searched Medline, PubMed Clinical Queries, and the Cochrane Database for systematic reviews published in 1996 through April 2007 on the assessment and management of acute pain in inpatients, including patients with impaired self-report or chemical dependencies. We conducted a focused search for studies on the timing and frequency of assessment, and on the use of patient-controlled analgesia (PCA) for nonsurgical pain. Two investigators performed a critical analysis of the literature and compiled narrative summaries to address the key questions. Results: We found no evidence that directly linked the timing, frequency, or method of pain assessment with outcomes or safety in medical inpatients. There is good evidence that treating abdominal pain does not compromise timely diagnosis and treatment of the surgical abdomen. Pain management teams and other systemwide interventions improve assessment and use of analgesics, but do not clearly affect pain outcomes. The safety and effectiveness of PCA in medical patients have not been studied. There is weak evidence that most cognitively impaired individuals can understand at least one self-assessment measure. Almost no evidence is available to guide management of pain in delirium. Evidence for managing pain in patients with substance abuse disorders or chronic opioid use is weak, being derived from case reports, retrospective studies, and expert opinion. Conclusions: Pain is a prevalent problem for medical inpatients. Clinical research is needed to guide the assessment and management of pain in this setting.

Original languageEnglish (US)
Pages (from-to)1183-1199
Number of pages17
JournalPain Medicine
Volume10
Issue number7
DOIs
StatePublished - Oct 2009
Externally publishedYes

Fingerprint

Acute Pain
Inpatients
Pain Management
Pain
Patient-Controlled Analgesia
Pain Measurement
Safety
Delirium
Expert Testimony
PubMed
Abdomen
Self Report
Abdominal Pain
Opioid Analgesics
Substance-Related Disorders
Analgesics
Retrospective Studies
Research Personnel
Databases
Research

Keywords

  • Hospital Medicine
  • Pain Management
  • Systematic Reviews

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine
  • Medicine(all)

Cite this

Assessment and management of acute pain in adult medical inpatients : A systematic review. / Helfand, Mark; Freeman, Michele.

In: Pain Medicine, Vol. 10, No. 7, 10.2009, p. 1183-1199.

Research output: Contribution to journalArticle

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