Attitudes to pain and pain relief in adult surgical patients

Abstract

SummaryPain relief after surgery is. frequently inadequate. In the last few years much research has been devoted to improving the situation. Unfortunately, very little work has been undertaken to explore the patients' contribution to pain management. The beliefs and attitudes held by patients when they enter the hospital environment may be responsible in some instances for their not achieving optimal pain relief from the available techniques. We have studied some of these attitudes with a survey of 180 adult patients admitted for elective surgery. We found that most patients still expect pain. following surgery. However, they are not afraid to ask for analgesics when in pain and do not attribute pain to their own wrong doing. There are, however, some patients who appear to have deviant’ pain beliefs that could hinder their appropriate use of analgesics. Sadly, it is impossible to identify these patients according to age, gender, socio‐economic group or previous experience of pain or surgery.

Public perceptions of postoperative pain and its relief

“…In this survey, attitudes to pain varied greatly and these results confirm the findings of other surveys performed immediately before or after surgery [3][4][5][6]. These show that, amongst the general public, there is little or no understanding of the nature of postoperative pain or of the methods currently available to treat it.…”

“…The publication in 1990 of the report of the working party of the Royal Colleges of Surgeons and Anaesthetists has led to some organisational improvements in the provision of pain relief after surgery [1] and, to meet the report recommendations, many hospitals have established pain teams which can achieve significant reductions in pain scores [2]. However, other surveys have highlighted the lack of improvement in some hospitals in staff attitudes to pain and the poor knowledge amongst patients in hospital awaiting surgery [3][4][5][6]. No data are available regarding the perceptions and knowledge that the general public have of postoperative pain or on the importance it places in the topic.…”

“…The published data clearly indicate that patients are likely both to suffer severe pain and to receive inadequate analgesia following major surgery [1][2][3][4][5][6], which may result in unnecessary postoperative morbidity [7]. Since the 1990 report of the working party of the Colleges of Surgeons and Anaesthetists, some organisational improvements in the provision of pain relief after surgery have been made and acute pain teams have been established to meet the report recommendations.…”

Patients’ Decision-Making Strategies for Managing Postoperative Pain

“…8,16 Patients may not disclose pain to clinicians because they are perceived to be too busy. 5,9,16,41 There is also a tendency for patients not to actively communicate with clinicians following operations about how they want their pain to be treated. 19 Satisfaction with pain management after surgery occurs when patients are included as an informed partner in discussions about analgesia options, 37 when pain is relieved effectively even though some degree of discomfort is anticipated, 23 and when clinicians show concern about how much pain patients are experiencing.…”

“…Instead, patients' perspectives on pain management have mainly been addressed with descriptions of their experience, 1,[7][8][9]16,19 their perceived satisfaction with care activities, 20,23,37 and their attitudes concerning the pain experience. 5,39 Common postoperative experiences relating to pain management include patients' refusal to accept analgesia, 8 patients behaving passively about asking for analgesia, and patients believing they have to tolerate pain. 8,16 Patients may not disclose pain to clinicians because they are perceived to be too busy.…”