Pain management in the hospitalized patient

Pain is a word that universally strikes fear. The alleviation of pain-a fundamental precept of the medical profession-is both a gratifying act and a clear obligation of anyone involved in healthcare. Like the common cold, everyone expects to experience pain occasionally. Unlike the symptoms associated with the common cold, physicians and other healthcare providers are poorly versed in addressing pain [1]. The societal cost of pain is enormous. Complaints related to pain are responsible for up to 80% of all doctor visits [2]. Some have estimated the cost at over $100 billion annually; however, because studies have shown that many respondents underreport pain, this figure is likely conservative [3]. Furthermore, the societal cost of pain will almost certainly rise as the general population ages. The development of the hospitalist model is an opportunity to address our present problems with pain management in the hospital setting. Hospitalists are uniquely positioned to both treat pain and teach other members of the healthcare team about the principles of pain management; however, the challenges that physicians face in this arena are not trivial. Pain management in the hospitalized patient requires an understanding of the mechanisms of pain, patient stress response, and pharmacokinetic and pharmacodynamic properties of drugs and how they relate to individual patients. This article will address our understanding of pain management in the hospitalized patient and the hospital doctor's role in addressing pain and teaching others about pain management.