ASSESSMENT OF POSTOPERATIVE PAIN

Pain is a subjective feeling; its assessment is therefore difficult, a nd no ''gold standard'' method exists for humans. Major improvements h ave, however, been made in the last decade by widespread acceptation o f the concept of pain evaluation and widespread use on surgical wards. Evaluation by the patient himself is the rule (unless communication i s impaired), as assessment of pain by nurses or doctors systematically leads to underestimation (which also occurs with observational scales ). Theoretically, pain should be evaluated in its multiple dimensions such as intensity, location, emotional consequences and semiologic cor relates. Scales which have been developed to evaluate these dimensions are, however, too complex for widespread and repetitive use in surgic al patients. The Mac Gill Pain Questionnaire is therefore only used in the surgical setting for research purposes. Moreover, its scientific accuracy, although often accepted, is poor and in our opinion cannot b e accepted as a reference method. Only methods assessing pain intensit y can be used in the clinical setting because of their simplicity. The verbal rating scale (VRS), the numerical rating scale (NRS) and the v isual analogue scale (VAS) are preferred by an increasing number of gr oups. Although scientific validation is difficult, VAS seems the most accurate and reproducible scale. Postoperative pain should be assessed several time!; a day in every patient, at rest and in dynamic conditi ons (cough, movement) and should focus on present pain rather than on pain in the previous hours. Assessment of pain is essential before qua lity-assurance programmes can be implemented. (C) 1998 Elsevier, Paris .