Benefits with pain and nociceptive assessment

Pain was defined as the 5th vital sign in 2002 by the US government, and pain is mandatory to assess in US, Russia, and most of the countries in Europe. Since then the satisfaction from patients has increased. However the deaths caused by respiratory depression due to opioids have also increased, as well as addiction to opioids (1.2.).

Assessing and treating pain is therefore in high focus in medicine and is essential for every clinician. If pain is not managed the patients can have delayed recovery, increased morbidity and mortality. In the US alone, the annual healthcare costs exceeds $600 billion.

The golden standard to assess pain is reported pain which is influenced by factors like anxiety, depression, previously painful events, existing pain and demographics due to the fact that pain experiences are being processed in the brain (supra spinal level) before reported. An objective assessment of pain and nociceptive stimuli enables clinicians to tailor the need of analgesia when needed. The PainMonitor device based on skin conductance changes, which is based on a nociceptive spinal reflex (3), is not influenced by e.g. anxiety levels in the peri-operative setting or changes in blood circulation. The PainMonitor device is therefore the most exact way of tailoring the level of analgesia to avoid opioid adverse effects in all patient groups during anaesthesia, in intensive care patients, postoperatively as well as in preterm infants.

Adverse effects from opioids:

• In 12% of the surgical patients side effect from analgesic medications lead to extra days of hospitalization, 27% extra costs per patient and increase in readmission.
• Up to 50% of surgical patients report moderate or severe post-operative pain (4.5.6.).

Direct consequences of excessive opioid use are:

• Post-operative nausea, vomiting (PONV)
• Respiratory depression
• Induced opioid hyperalgesia
• Constipation
• Delirium
• Delayed post-operative recovery
• Reduced patient satisfaction

Direct consequences of insufficient opioid/analgesia use are:

• Hypertension, tachycardia
• Heart ischemia
• Increased morbidity
• Delayed post-operative recovery
• Reduced patient satisfaction

References:

1.Vila H, Smith RA, Augustynaik MJ, et al. The efficacy and safety of painmanagement before and after implemention of hospital-wide pain management standards: is patient safety compromised by treatment based solely on numerical pain ratings? Anesth Analg 2005; 101:474–480.

2. Sentinel event alert: preventing, and managing the impact of anesthesia awareness. Oakbrook terrace, IL: Joint Commission, 2004. http://www.joint commission.org/SentinelEvents/SentinalEventAlert/sea_32.htm. [Accessed February 19, 2008]..

3. Storm H, Günther A, Sackey JP, Bernhardsson J, Bjärtå A. Measuring pain – hysiological and self-rated measurements in relation to pain stimulation and anxiety. Acta Anaesthesiol Scand. 2019;1–8.

4. Pain-out.med.uni-jena.de.

5. Incidence, patients satisfaction, and perceptions pf post-surgical pain: Results from a US national survey. Current Medical Research and Opinion. Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. (2014)2014;30(1):149–60.

6. A Prospective Multicenter Study to Improve Postoperative Pain: Identification of Potentialities and Problems. Pogatzki-Zahn E, Kutschar P, Nestler N,Osterbrink J (2015) PLoS ONE 10(11): e0143508.