What pain is acceptable

Unacceptable pain

The authors can only be congratulated on this excellent work (1), which appears on time for the start of the “Global Year Against Acute Pain” announced by the International Association for the Study of Pain (IASP). Even if the target parameter of “unacceptable” pain certainly needs additional validation in other patient groups, the study shows the glaring deficiencies in analgesic care in German clinics. The fact that more than half of the patients have to endure unacceptable pain after routine interventions such as cholecystectomies, thyroidectomies or herniotomies is unacceptable in view of the analgesics available today and existing guidelines for their use.

As stated by the authors, the study reflects major deficits in the area of ​​knowledge and implementation of analgesic algorithms and, in particular, in the area of ​​clinical organizational structures. Clinical pathways are an effective means of bringing effective pain therapy to the patient's bedside. These treatment instruments define standardized diagnostic and therapeutic treatment steps for specific clinical pictures or interventions (2). In a study we compared kidney transplant patients who were treated according to a clinical pathway, which provided for a defined pain therapy according to the WHO grading scheme for each patient, with a historical control group who were treated without a standardized analgesic scheme. As an expression of a better analgesic attitude, it was found that pathway patients had to request additional pain medication significantly less often (3).

Based on these results, we would like to encourage the use of clinical pathways in both the perioperative and the conservative setting. In our opinion, provided that they are properly created, implemented and continuously used, they can contribute to the development of Maier et al. to improve the shockingly inadequate analgesic care presented in the long term.

DOI: 10.3238 / arztebl.2010.0844

Dr. med. Ulrich Ronellenfitsch
University Medicine Mannheim
Surgical Clinic
Theodor-Kutzer-Ufer 1–3
68167 Mannheim
Email: [email protected]

Prof. Dr. med. Matthias Schwarzbach

Clinic for general, visceral, vascular and thoracic surgery

Klinikum Frankfurt Höchst GmbH

Gotenstrasse 6–8

65929 Frankfurt a. M.

Email: [email protected]

Conflict of interest

The authors declare that there is no conflict of interest within the meaning of the guidelines of the International Committee of Medical Journal Editors.

The authors of the article have omitted a closing word.

Maier Ch, Nestler N, Richter H, et al .: The quality of pain management in German hospitals. Dtsch Arztebl Int 2010; 107 (36): 607-14. FULL TEXT
Schwarzbach M, Ronellenfitsch U: Clinical Paths in Surgery: An Instrument for Routine Operation? Dtsch Arztebl 2008; 105 (47): A2512. FULL TEXT
Schwarzbach M, Bönninghoff R, Harrer K, et al .: Effects of a clinical pathway on quality of care in kidney transplantation: a non-randomized clinical trial. Langenbeck's Arch Surg 2010; 395 (1): 11-7. MEDLINE