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How to Improve Post-Operative Pain Care?

Rianne van Boekel – Radboud University Medical Center, Netherlands

“Improving postoperative pain care” – this is the title of an impressing thesis from Rianne van Boekel where she analyses the quality of postoperative pain management in Dutch Hospitals. We have asked Rianne to provide us some insights in her extensive Research.

What has triggered your interest to start this research?

I have written down some quotes I have heard a lot of times, when attending my shift of the acute pain service at the Radboud university medical center. They inspired me to reflect on my knowledge and my work. Some questions were raised. For example, can patients, being treated perfectly according to the guidelines, still be in pain? How do I need to treat patients who claim that pain is acceptable to them, when having high pain scores. Is it true that patients who are in too much pain develop complications?

Who was involved and what were the main findings?

I performed my research at the Department of Anesthesiology Pain and Palliative Medicine at the Radboud university medical center in Nijmegen, the Netherlands. I worked together with the team of anesthesiologists and pain nurses of the Acute Pain Service, in particular Monique Steegers, Jos Lerou and Kris Vissers.

In my thesis I presented the results of seven separate studies:

  1. a description of the Dutch APS teams in Hospitals,
  2. an analysis of the compliance with pain assessment in postoperative patients after implementation of the Dutch Hospital Patient Safety Program and influencing factors, based on information of hospital contact respondents and based on patient records,
  3. a description of the prevalence of acute postoperative pain in a tertiary high academic hospital setting in the Netherlands,
  4. an analysis of the outcome of different pain management techniques after major surgery,
  5. an analysis of the association between several components of pain assessment, and
  6. an analysis of the association between unacceptable postoperative pain and complications after surgery.

Our results demonstrated that postoperative pain management can be improved by

  1. optimizing APS teams,
  2. performing frequent multidimensional pain assessments and by
  3. evaluating outcome measures including postoperative complications.

Using the Donabedian model, we have shown that the structure, the process, as well as the outcome of postoperative pain management are interrelated factors. In order to improve postoperative pain management, all the influencing factors need to be addressed. Therefore, a hospital-wide improvement program is necessary which reviews the role of APS teams and other professionals, and focuses on the improvement of adherence to multidimensional pain assessment and the evaluation of pain treatment according to the Plan-Check-Do-Act cycle (PDCA cycle). The program evaluation should include measures of the intensity of the pain, the patient’s opinion on the acceptability of the pain, the observation of physical function, and the development of complications after surgery. The conclusions and recommendations presented in my thesis can be used to assess the situation in the reader’s own hospital to improve the organization of postoperative pain Management.

How will you use the results to improve postoperative pain care in the future?

My goal is to prevent patients from unnecessary suffering caused by postoperative pain. I believe that postoperative pain management can be improved by optimizing APS teams, optimizing frequent pain assessments, and by analyzing patient outcomes. But we need to work together with our patients in achieving this goal. We need to empower them and embrace shared decision making. Because they are the ones actually feeling the pain. Without their cooperation and consent, pain management can never be optimal. In my work as the hospital-wide process supervisor patient empowerment is my first priority.

I will continue advocating the importance of adequate assessment and treatment of postoperative pain, in the clinic on individual patients as well as during education and training sessions for health care professionals. Additionally, I will continue advocating the analysis of pain data and facilitate quality improvement projects. Finally I will continue my research on postoperative pain management, with the help of our patients.


Rianne, thanks a lot and congratulations to this great work. More detailed information can be found here.