Pain in medical inpatients: an under-recognised problem?

Pain is a common feature of a range of illnesses. Although it is perceived as a significant problem for surgical patients and those with terminal malignancy, there is a paucity of evidence regarding the prevalence of pain in general medical patients. This study set out to determine pain prevalence and the contribution of chronic pain in a teaching hospital medical unit. All wards on the medical unit were visited on three consecutive days and all eligible patients were asked to complete a questionnaire indicating occurrence and severity of pain. Their analgesic prescriptions were also reviewed. A total of 156 patients took part, representing 85% of all inpatients. Chronic pain prior to admission was a common finding, being reported by 57 (37%) of patients and was associated with the occurrence of pain and severe pain (pain score >6) while an inpatient. Overall, 53% of patients experienced pain, 38% had severe pain and 18% had less than 50% analgesic efficacy. Prescription of non-recommended analgesics was common, and was strongly associated with the occurrence of pain (odds ratio 12, 95% confidence interval 4-38). Large numbers of patients had contraindications to commonly prescribed medications. Dissatisfaction was closely linked to poor response to prescribed analgesics, non-recommended prescription and severe pain. Pain is common among medical patients. Chronic pain is a major problem and complicates the issue of analgesic prescription. There is considerable scope for improvement in the management of pain among medical patients. However, pain control for these patients is likely to be more complex than for surgical patients.