Health: Post-operative pain relief a matter of geography

Choosing the right hospital for your operation can dramatically reduce the pain you suffer as a result. Jeremy Laurance, Health Editor, examines a major report into anaesthetic services in the National Health Service.

Most patients believe pain is unavoidable after surgery. But an investigation by the Audit Commission, the official National Health Service watchdog, to be published this week, shows that there are wide differences between hospitals. It found that where you have the surgery is as important as the kind of operation in determining the amount of pain you suffer.

A study of hernia patients, conducted as part of the commission's investigation, found "significant variations" among hospitals in the proportion of patients who suffered "moderate" or "severe" pain. About 80,000 hernias are carried out each year and it is one of the commonest operations performed on the NHS.

Patients in hospitals with acute pain teams - staff specially trained in techniques to deal with it - had the least pain but only 57 per cent of hospitals have such teams. More than one in three hospitals do not bother to assess patients' pain regularly on all surgical wards.

The report, "Anaesthesia Under Examination", also found that there has been no reduction in overall levels of pain experienced by NHS patients over the past 25 years, despite advances in treatment and drugs.

Dr Chris Glynn, consultant anaesthetist at the Oxford Radcliffe Hospitals NHS Trust and author of a 1995 survey of pain services in hospitals, said: "Pain is the worst taught and worst managed subject in medical school. In hospitals, medical staff measure blood pressure and temperature and a whole range of other things, but they don't measure pain."

Pain can be measured simply by asking patients to mark a point on a scale ranging from no pain to severe pain. Nurses then provide painkillers and can vary their strength according to whether subsequent measurements show the pain growing or reducing. "This has been shown to be the single most important way of reducing pain - by getting staff to measure it," Dr Glynn said.

The Audit Commission study, which also covers pain control in childbirth and for people with chronic conditions, shows that the likelihood of finding a hospital with an acute pain team varies widely around the country. In the North Thames region, covering north London and the home counties, almost 75 per cent of hospitals have the teams; but in the South Thames region, covering south London, Kent and Surrey, fewer than half do.

Anaesthetists warned, however, that pain is subjective and the same operation by the same surgeon with the same anaesthetist can leave one patient doubled up while another is pain-free.

One consultant said: "The simplest way to deal with pain is to render the patient largely unconscious but you don't want them to breathe less because then they get pneumonia. There is a limit to how much pain you can get rid of, or would want to."

The Royal College of Anaesthetists declined to comment on the Audit Commission report in advance of its publication.

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