Personalised and precision pain medicine--a dream coming true?

1Department of Anaesthesia, National University Hospital, Singapore 2Department of Anaesthesia, National University of Singapore, Singapore Address for Correspondence: Dr Keah How Poon, Department of Anaesthesia, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074. Email: [email protected] In the past 10 years, numerous leaders in pain management have pioneered efforts to raise the awareness of pain medicine. Two notable initiatives included the Decade of Pain Control and Research (2000 – 2010) and the Global Day Against Pain.1,2 These initiatives have contributed to an increase visibility of pain in daily clinical care settings. All hospitals in Singapore are now accredited by the Joint Commission International and in accordance with the standards exacted, pain is now the fi fth vital sign. The “pain load” in an acute tertiary hospital care setting is high. We surveyed 400 inpatients in an audit in 2007 and found the pain prevalence over a 24-hour period to be 51%. More recently, a survey of 736 post elective surgical inpatients revealed that the prevalence of moderate to severe dynamic pain was 53%. When we looked at the data more closely, we were surprised that patients who underwent what we believed were minor surgeries reported more pain than what we had expected. This was consistent with the experience reported by Gerbershagen recently on 50,523 patients from 105 German hospitals.3 They found that pain scores were often worst in what we considered “minor” procedures such as appendicectomy and tonsillectomy. The authors hypothesised that the reasons could be due to less analgesics administered to these patients due to physicians erroneous preconception.