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A Conway Morris, N Howie
Journal Issue: 
Volume 39: Issue 4: 2009




Pain is a common feature of a range of illnesses.  Although it is perceived as a significant problem for surgical patients and those with terminal malignancy, there is a paucity of evidence regarding the prevalence of pain in general medical patients. This study set out to determine pain prevalence and the contribution of chronic pain in a teaching hospital medical unit. All wards on the medical unit were visited on three consecutive  days  and  all  eligible  patients  were  asked  to  complete  a  questionnaire indicating  occurrence  and  severity  of  pain. Their  analgesic  prescriptions  were  also reviewed.  A total of 156 patients took part, representing 85% of all inpatients. Chronic pain prior to admission was a common finding, being reported by 57 (37%) of patients and was associated with the occurrence of pain and severe pain (pain score >6) while an inpatient. Overall, 53% of patients experienced pain, 38% had severe pain and 18% had less than 50% analgesic efficacy. Prescription of non-recommended analgesics was common, and was strongly associated with the occurrence of pain (odds ratio 12, 95% confidence  interval  4–38).  Large  numbers  of  patients  had  contraindications  to commonly  prescribed  medications.  Dissatisfaction  was  closely  linked  to  poor response  to  prescribed  analgesics,  non-recommended  prescription  and  severe  pain. Pain  is  common  among  medical  patients.  Chronic  pain  is  a  major  problem  and complicates  the  issue  of  analgesic  prescription.  There  is  considerable  scope  for improvement  in  the  management  of  pain  among  medical  patients.  However,  pain control for these patients is likely to be more complex than for surgical patients.