There has been an increased emphasis on the treatment of acute pain since JCAHO considered pain as the 5th vital sign with a focus on assessment and reassessment after treatment. Historically, pain was a natural, inevitable, acceptable and harmless consequence of surgery and trauma. Now, however, we know that severe untreated acute pain and stress response to surgery can lead to adverse consequences such as myocardial ischemia, pneumonia or persistent chronic pain which is a growing entity among patients.
In the last century, the World Health Organization developed the ladder to treat cancer pain patients. Currently, this is still in use for post operative pain although there has been with some modification and more modern terminology such as preemptive analgesia and multimodal analgesia. Since the 1990s, advancement of epidural analgesia and, more recently, peri-neural catheters have added new modalities in post operative and acute pain management. Some authors propose adding step four to the ladder to include the above pain intervention procedures.
There has been significant improvement in acute pain management in the last 20 years including the introduction of patient controlled analgesia (PCA) ; the introduction of epidural analgesia: the use of newer drugs and combining them in the multimodal and preemptive analgesia: and the establishment of the acute pain service. The first Anesthesiology-Based Acute Pain Service in the United States was started in 1986 by Dr. Ready at the University of Washington, Seattle.
At UMass Memorial Medical Center, the dedicated acute pain service was reestablished in 2007 as a dedicated service to provide post operative pain management through regional blocks and acute pain management consults/recommendations to various specialties in treating complex patients. In the last decade, ultrasound-guided regional blocks have revolutionized the technique of performing nerve blocks compared with paresthesia or nerve stimulator guided blocks. Since the introduction of ultrasonography for regional blocks, the success rate of regional blocks exceeded 95%.
In addition to preemptive, multimodal analgesia and regional blocks, the acute pain service provides help to cancer pain patients and acute therapies for chronic pain patients who are admitted to the hospital for pain management through the integration between the acute and chronic pain physicians for a more advanced pain procedures beyond the scope of practice of acute pain physicians.