Prevalence of Acute Pain

Benjamin W. Friedman, MD, MS: Hello, and thank you for joining this Patient Care® Around the Practice program, “Updates in the Management of Acute Pain With Novel Technology.” I’m Benjamin Friedman, a professor in the department of emergency medicine at the Albert Einstein College of Medicine in the Bronx, New York. I’m joined by Francesca Beaudoin, an associate professor of epidemiology and emergency medicine and health services, policy, and practice at Brown University, and an attending physician at Brown Emergency Medicine in Providence, Rhode Island; Paul Arnstein, a clinical nurse specialist for pain relief at Massachusetts General Hospital in Boston; and Jeff Gudin, an attending physician of anesthesiology and pain management at the University of Miami Miller School of Medicine in Florida.

In addition to reviewing the management of acute pain, we’ll also present 2 hypothetical patient cases and talk through approaches to treatment. Let’s begin. Dr Beaudoin, I’m going to turn it over to you to talk about the prevalence of acute pain and its different subtypes.

Francesca Beaudoin, MD, MS, PhD: Thanks so much, Ben. It’s good to see you all this morning. I’m happy to talk about this important topic. In talking about acute pain, and specifically the prevalence of acute pain, we should think about the different scenarios in which it can occur. After certain instances, such as trauma, injury, or surgery, acute pain is almost ubiquitous and highly prevalent. I’d push a little further in that instead of just thinking about acute pain, which can vary quite a bit from mild to severe pain that interferes with function and sleep, we should think about not just the prevalence of acute pain but the prevalence of acute pain that interferes with quality of life or function. Depending on the types of acute pain we’re talking about—postoperative pain, post-traumatic pain, or pain following spontaneous injuries—that can vary quite a bit.

Then we should probably take it a step further and think about how much of that acute pain then transitions to persistent or chronic pain. For instance, following specific types of surgery, such as mastectomy or thoracotomy, the prevalence of moderate-to-severe acute pain is quite high. In some reports, the proportion of people who have pain weeks after surgery can be as high as 50% or 80%. I’d be interested to know what my colleagues think about this as well.

Jeff Gudin, MD: Francesca, you bring up a great point. For those of us in the pain management world or even in the ED [emergency department] setting, because we see these things, we’re familiar with post-mastectomy, post-herniorrhaphy, and post-thoracotomy pain. But think about your primary care physicians out there. A patient goes home, and a few weeks after a surgery, they come in with intense pain in the part of the body where they had their surgery. It’s an area that we know well, but it certainly could serve some education in the community.

Francesca Beaudoin, MD, MS, PhD: Yes, that’s totally on point. The most common types of pain that primary care physicians and other practitioners are going to see are probably pain after trauma and injury. That’s fairly common. The types of traumatic pain that lead to acute pain include motor vehicle crashes, which are one of the most common types of traumatic events. Those are set up for both acute and persistent and chronic pain because they involve tissue trauma but also combine with a perceived life threat or stressful event in a lot of cases. That combination of tissue injury and psychological and emotional stress are setups for pain and the consequences of acute pain.

Transcript Edited for Clarity