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Go to our site at: www.onthewards.org A series of podcasts offering advice to hospital based doctors in the earliest stage of their careers when they first work on the wards. Now celebrating our 100th podcast!Read more »
Most Recent Episode
Chronic post-surgical pain
Summary: Rose McCarthy
Editor: Jane Standen
With Dr Jane Standen, Consultant Anaesthetist and Interventional Pain Specialist, Sydney, Australia
James talks to Dr Jane Standen about chronic post-surgical pain.
Jane is s Consultant Anaesthetist and interventional Pain Specialist. She studied medicine at the University of Sydney and trained in anaesthesia at the Prince of Wales Hospital, Sydney. Subspecialty training in pain management was undertaken at the Michael J Cousins Pain Management and Research Centre at Royal North Shore Hospital.
Jane has expertise in the treatment of both early onset and persistent pain. She specialises in minimally invasive procedures, aiming to reduce pain and enhance quality of life. She practices with an empathetic manner and takes an evidence-based approach.
Jane is an honorary tutor with the University of Sydney Masters in Pain Management and is actively involved in pain management education at the Mater Hospital and Royal North Shore Hospital. She regularly conducts GP educational sessions.
She is appointed at Norwest Private Hospital, the Sydney Adventist Hospital, the Mater Hospital and Royal North Shore Hospital.
[efitems title="Introduction " text="
By definition, chronic post-surgical pain is new pain post-surgery that persists outside the time of normal wound healing. The definition is currently changing according to the International Classification of Disease 11 to ”persistent pain continuing at 3 months post-surgery or significant tissue trauma”. Managing chronic post-surgical pain can be challenging and may require close management by a multidisciplinary team."]
Case - You are asked to see a gentleman on the wards who is waiting for pleurodesis for recurrent pneumothoraces. He has a background of depression and is very apprehensive about the procedure, He has 6/10 pain and is distressed wanting the procedure done now saying "dying of pain".
[efitems title="1. Initial approach" text="
Challenging patient for a junior doctor - in this type of patient, it is difficult to determine how much pain is due to pain generators and how much is attributed to distress
Do not engage in the patient's distress - remain calm
An empathetic approach will be the easiest way to manage the situation
Take their issues seriously and validate their concerns
Seek senior support if you feel the situation will escalate
Consider erring on the side of caution if the patient is waiting for surgery
Provide analgesia appropriate to what the patient is describing
Consider that the patient may be apprehensive of aspects of the procedure
For example, the general anaesthetic - it may be appropriate for the anaesthetic registrar to come and talk to the patient
If the patient has a significant history of a mental health problem, it should be optimised before the patient has surgery
Determine if they take anti-depressant/ anti-psychotic medications
Determine if there is suicidality risk
Consider if a mental health officer needs to be involved "]
[efitems title="2. How do we reduce the risk of chronic post-surgical pain occurring? Why does it matter?" text="
Chronic post-surgical pain matters because persistent pain can interfere with a patient's ability to function which has both societal and vocational considerations
Reducing the risk of chronic post-surgical pain involves:
Assess the patient
Perform psychometric scoring
For example, levels of anxiety, depression, pre-operative catastrophisation - with higher scores reflecting greater incidence of post-operative chronic surgical pain
Consider if psychometric factors can be modified - however this is difficult if the patient is in hospital and due for surgery within 24 hours
Other factors for higher risk of chronic post-surgical pain: younger patients, female patients and patie...Read more »