The quality of pain management in German hospitals

Abstract

Background: The Pain-Free Hospital Project was initiated in 2003 with the aim of improving pain management throughout Germany. We assessed the current state of pain management in German hospitals.

Methods: From 2004 to 2006, data were obtained anonymously from 2252 patients who had undergone surgery, and 999 who had been treated non-surgically, in a total of 25 hospitals. They were interviewed about the intensity of pain they had experienced and about the effectiveness of its treatment.

Results: No pain at all was reported by 12.4% of patients who had undergone surgery and by 16.7% of the non-surgically treated patients. Moderate to severe pain at rest was reported by 29.5% of the surgical group and 36.8% of the non-surgical group. More than 50% of the overall group reported pain on movement. 55% of the surgical group, and 57% of the non-surgical group, were dissatisfied with their pain management. Peak pain tended to occur outside normal working hours. No analgesic treatment at all was given to 39% of patients in the non-surgical group, even though they were in pain; the corresponding figure for the surgical group was 15% (a significant difference, p<0.001). Inadequately effective pain management was reported by 45.6% of patients in the non-surgical group and 29.6% in the operative group (again, a significant difference. Cancer patients were treated more often with potent opioids.

Conclusion: Severe postoperative pain is still too common among hospitalized patients, particularly pain that is induced by movement. Patients being treated on non-surgical wards also often suffer severe pain needlessly. Pain management seems to be worse for non-surgical patients (cancer patients excepted) than for surgical patients: waiting times for medication are longer, and ineffective medications are given more often. On the other hand, a number of hospitals provide positive examples of the potential effectiveness of pain management for both surgical and non-surgical patients.

Figure 1

Mean values (±standard error of mean, SEM) for a) resting pain, b) pain on initial activity/exertion, and c) maximum pain, subdivided into groups of patients who rated their pain therapy differently (school marks 1–6; marks 5 and 6 are combined because the number of cases is too small). NRS, numerical rating scale (NRS 0–10)

Figure 2

Proportion of pain-free patients receiving pain therapy (light olive shading), patients with acceptable (medium olive shading) and unacceptable (dark olive shading) pain scores; data about resting pain, pain on initial activity/exertion, and maximum pain combined, respectively; patients with pain: top: patients on wards delivering non-surgical treatment, classified by underlying pathology. Bottom: surgical patients after different procedures. The list includes disorders/operations only where n>25

Figure 3

Frequency of severe pain (different types of pain) in surgical patients (light olive bar) and non-surgical patients (dark olive bar)

Figure 4

Distribution of resting pain (box plot with 25%/75% quartiles and median) in different hospitals (dark olive box plot: mean value of all listed hospitals) in 80 patients after surgery for inguinal hernia (left, 17 hospitals) and 98 patients with cardiac pain due to coronary heart disease (right, 18 hospitals). NRS, numerical rating scale (NRS 0–10)