You’ve just had surgery. You’re glad it went well, but you’re in pain. You want relief and you want it NOW.
Depending on the options available, either you wait to ask a nurse for more pain killers or you simply press a button that operates an electronically controlled pump connected to your IV tube and a dose of pain medication is immediately released into your system.
Many patients still depend on medical staff to dispense medications, usually at specific times according to doctors’ orders. Dr. Jason Busse and his colleagues at McMaster University focus on understanding and treating persistent pain after surgery, generally managed by pain killers such as morphine.
He points out some drawbacks with a staff-managed approach: “Everybody experiences discomfort differently… some patients will require a little bit more, some a little bit less.” Patients may also be hesitant to interrupt nurses to ask for more drugs, which can add to their anxiety and sense of helplessness. “People who are more worried tend to experience more pain. So if you can provide some sense of control - that is going to address some of the anxiety they have about their recovery.”
That’s where PCA – patient controlled analgesia – comes in. Since the development in the late 1960s of special devices (1;2) it is becoming more common for patients to administer the drugs themselves (3). There are built-in safeguards to prevent overdoses – the devices are programmed to dispense a limited amount of the drug at a time (4;6) and Dr. Busse says patients typically have to wait 10 to 15 minutes between doses.
Studies consistently show that PCA is the preferred approach to pain management as it ensures patients get their pain medications without delay (5). But just because they have more control, do they really have less pain? And are there any risks to their personal safety?
Those are the questions a recent systematic review hoped to answer. It included 49 randomized controlled trials involving more than 3,400 study participants who had undergone surgery (6). A little more than half received PCA while patients in a control group waited for nursing staff to dispense medication. Pain “scores” for both groups were measured and recorded for up to a few days after surgery.
What the research tells us
Giving patients control over their pain medications does appear to lead to a modest reduction in pain. But perhaps more interesting (and an even stronger result in this study) is that 81% of those in control of their pain medication were satisfied with their pain management versus only 61% who did not have this option (6). “That is significant,” says Dr. Busse. As he points out, this satisfaction may come more from patients’ feelings of engagement in their own recovery after surgery, as opposed to any dramatic difference in pain relief.
As might be expected, PCA patients used more of the pain killing drugs – particularly on the second day following surgery. However, the difference was small and there was no significant difference in serious side effects (e.g. nausea/vomiting or breathing problems) between those who controlled their own pain medication and those who did not. There was also no significant difference in patients’ length of hospital stay (6). Only itching was more common among PCA patients (15% vs. 8%).
“So maybe a little more itchiness, significantly more satisfaction and a little more pain relief… probably the majority of patients would be comfortable with that tradeoff,” Dr. Busse says.
As he points out, there are enough reasons to feel nervous and vulnerable when you’re having surgery and very few opportunities to feel empowered. Being in control of your own pain medication may help ease both body and mind.