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Audit of pain

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Aysen Yucel, MD. Prof. of Anesthesiology. President of Turkish Chapter of IASP . Department of Algology. Medical Faculty of Istanbul University

Millions of people suffer from chronic or intractable pain. Persistent pain varies in etiology and presentation. In some cases, symptoms and signs may be evident within a few weeks to a few months after the occurrence of an injury or the onset of disease. The cause of pain is not always known or apparent. For many patients initial medical evaluation and treatments effectively relieve pain that might otherwise become chronic. Pain and its many manifestations may be poorly treated or underestimated. Inappropriately treated pain seriously compromises.

Pain treatment has been popularised among the physicians from several disciplines during the last decades. Most of these physicians work on the individual base. In fact the organisation of pain clinics is an important task for all the physicians involved in pain treatment. Pain enthusiasts of different disciplines in medicine are trying to popularize pain therapy in their countries according to their own desires. Pain medicine is still not integrated into the health care systems in most of the countries.

We come to a point of asking to ourselves : How pain medicine will continue to grow on the world wide basis, what will be the principles of developing new centres in underdeveloped and developing countries and how will the new pain enthusiasts be trained.

A pain clinic must include all multidisciplinary facilities for the pain treatment and should begin to serve as an outpatient clinic with several facilities. Evaluation of the patient should be performed by a multidisciplinary approach. During this multidisciplinary approach an anesthesiologist who is familiar with pain, a physical therapist and a neurologist must be involved. The pain clinic must also have a consultation team of physicians who will meet weekly and discuss the important cases if necessary. On the educational aspect, the pain clinic must be a power point which will motivate the physicians and encourage them to be involved in the pain field.

To ensure quality of pain management, the programs need to document their effectiveness. For evaluation of treatment outcome relevant assessment methods are necessary. The large variety of measures described in the literature show that selection of relevant parameters is difficult for the audit of acute and chronic pain.

In Turkey the first pain unit was established in 1986 as an outpatient clinic. In the first year 500 new patients were admitted. During the following years the pain field has became popular in Turkey and the annual number of new patients increased gradually up to 2500. In 1990 Algology has been approved by the Supreme Council of Education as a division of Anesthesiology in the Medical Faculties. Today 15 Departments of Algology other than The Department of Algology of Medical Faculty of Istanbul University were established.

We audited and analysed the efficacy and safety of pain management on the patients under care of our Department of Algology. The distribution of pain and the invasive procedures for the treatment of pain in 1999 are :

 
n
%
 
n
Cancer pain
900
42.67
DDS
53
Headache
440
20.86
Epidural steroid
118
Low back pain
400
18.96
Epidural lysis
29
Neuropathy/Neuralgia
142
6.75
RFTC
58
Neck-shoulder-arm pain
91
4.31
Sympath. Blocks
103
Periph. Vasc. diseases
85
4.03
T. point inj.
118
Others
51
2. 41
Others
126
Total
2109
  Total
505

Pain management is an emerging discipline emphasising an interdisciplinary approach with a goal of functional restoration and reduction of pain and suffering. A comprehensive history and physical examination, diagnostic evaluation, multidisciplinary pain management and monitoring and measurement of clinical outcomes ; reduce pain, reduce adverse effects of pain therapy, improve function and quality of life and provide optimal utilisation and cost of services. Audit of pain should be an important component of pain therapy programs.

References

Arner S, Killander E, Westerberg H : Poor leadership behind poor pain relief. Medical audit of cancer-related pain treatment. Lakartidningen 96(1-2) : 33-36, 1999.
Becker N, Thomsen AB, Olsen AK, Sjogren P, Bech P, Eriksen J : Pain epidemiology and healt related quality of life in chronic non-malignant pain patients referred to a Danish multidisciplinary pain center. Pain 73 : 393-400, 1997.
Davies HT, Crombie IK, Brown JH, Martin C : Diminishing returns or appropriate treatment strategy ? -an analysis of short-term outcomes after pain clinic treatment. Pain 70 : 203-208, 1997.
Dudgeon DJ, Harlos M, Clinch JJ : The Edmonton Symptom Assessment Scale (ESAS) as an audit tool. J Palliat Care 15(3) : 14-19, 1999.
Kay NR, Morris-Jones H : Pain clinic management of medico-legal litigants. Injury 29(4) : 305-308, 1998.
Quinn R : How to improve clinical practice in pain treatment : consultation clinician, patient education and quality improvement. In : Pain 1999-An Updated Review, Ed. Max M, IASP Press, pp : 363-367, 1999.
Sartain JB, Barry JJ : The impact of an acute pain service on postoperative pain management. Anaesth Intensive Care, 27(4) : 375-380, 1999.

Pain in Europe III. EFIC 2000, Nice, France, September 26-29, 2000. Abstracts book, p. 174 - 175.

   

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