Incidence

In 1990, The Royal College of Surgeons (RCS) report ‘pain after surgery’ found 30–70% patients with moderate or worse pain after surgery. A recent review finds that although the incidence of post-operative pain has reduced by ~2%/year for the last 30 years, 30% of patients still complain of moderate pain and 11% severe pain.

Factors affecting the severity of post-operative pain

Expected pain and analgesic requirements following surgery are extremely variable:

Type of surgery

• Size of the wound, amount of tissue damage.

• Muscle cutting or splitting incision.

• Technique, delicacy of dissection and retraction, type of stitch.

Site of surgery

• Movement of damaged tissues (e.g. chest and upper abdominal surgery).

• Oedema in a confined space (e.g. total knee replacement).

Patient factors

• Age, sex, medical condition and emotional state.

• Reason for/outcome of surgery.

• Other sources of distress: nausea, sleeplessness, noise.

• Home circumstances, anxiety about family, work.

Cultural background

• Attitudes to illness, treatment and pain.

Advantages of effective treatment

The fundamental imperative to treat post-operative pain is humanitarian; ‘It is the basic duty of all health care professionals to relieve pain’ RCS Report on Pain after Surgery 1990. We should not tolerate people suffering pain when effective treatment is readily available.