Clinicians who care for patients have an ethical obligation to relieve pain and suffering using a combination of approaches including medical, pharmacological, and psychological. According to the Agency of Healthcare Research and Quality (AHRQ), the most reliable indicator of the existence and intensity of pain is the patient's self-report (Potter and Perry 2009).

The AHRQ developed clinical practice guidelines on acute pain management and contends that all patients should be assessed and reassessed for severity of pain using a rating scale or a visual analogue scale. Pain is now classified as the fifth vital sign which then requires that pain should be assessed and reassessed at a minimum when vital signs are obtained (Smeltzer et al. 2008). It is important to remember that not all patients respond to pain in the same manner. Basic measures of pain intensity should be prioritized with the patient's self-report as the most important measure. Other measures of pain intensity include exposure to a painful procedure; behavioral signs, such as crying or restlessness; a proxy pain rating by someone who knows the patient well; and the psychological indicators such as elevated vital signs.

The clinician must accept and respect the patient's report of pain and proceed with an appropriate assessment and treatment. The clinician is entitled to a personal opinion but should not allow it to guide practice. Patients of differing cultures respond to pain and express pain differently, and the clinician needs to be aware of this (Smeltzer et al. 2008).

Symptomatic relief of pain should be provided while the investigation of cause proceeds. Unrelieved pain may be dangerous and is unacceptable. Postoperative pain can delay healing and contribute to complications that can be life threatening. Acute pain warns of actual or potential tissue damage and resolves when healing has occurred. Unrelieved postoperative pain is a complication or risk, not an acceptable consequence of surgery (2). Good pain management promotes healing and can result in shorter hospital stays and reduce admissions and readmissions.

The Joint Commission which accredits health-care institution provides guidelines for how facilities should educate, assess, and manage pain. The standard states that "the hospital must assess and manage pain." The Joint Commission also encourages patients to speak up and provides tools for clinician to use in informing patients (Fig. 17.1) ( 2010).

N. Vadivelu et al. (eds.), Essentials of Pain Management,

DOI 10.1007/978-0-387-87579-8_17, © Springer Science+Business Media, LLC 2011

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