Factors contributing to poor post-operative abdominal pain management in adult patients: a review.

Post-operative abdominal pain management can be a major issue facing medical and nursing staff in daily clinical practice. Effective pain control reduces post-operative morbidity as well as facilitates rehabilitation and accelerates recovery from surgery. In turn, poor pain control has been shown to alter body metabolic response that can lead to delayed recovery, with subsequent prolonged hospital stay and increased morbidity, and can lead to the development of a chronic pain state. Despite the significant developments in anaesthesia, delivery techniques and analgesia, post-operative abdominal pain management in adult patients remains suboptimal. Achieving effective pain management needs the implementation of an active approach in practice. This approach includes the provision of information and appropriate education tailored to the patients' needs and level of understanding, with the aim of reducing patient anxiety and avoiding unrealistic expectations. In addition, medical and nursing staff should continuously use the appropriate pain assessment tools to evaluate of post-operative pain in the surgical wards. Pain assessment needs to be regarded as the fifth vital sign and recorded on the patients observation chart. Analgesia should be used in a multimodal fashion and "by the clock" according to the patients needs. Moreover, governmental and professional guidelines need to be implemented to establish continuity of care, improve the quality of decision making and reduce unnecessary variations in practice Overall, there is a need for improved post-operative abdominal pain management in adults to enhance recovery, patient safety and reduce morbidity. This can be achieved with the appropriate education backed up with robust policies and guidelines, supported by up to date evidence. Copyright (c) 2009 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.