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ROBW. HUTCHISON, PHARM.D., is Assistant Professor, Texas Tech School of Pharmacy, Clinical Pharmacy Specialist in Pain Management, Presbyterian Hospital of Dallas, Dallas, TX.

Address correspondence to Dr. Hutchison at Presbyterian Hospital of Dallas, Jackson Building Suite 205, 8200 Walnut Hill Lane, Dallas, TX 75231 (robhutchison{at}texashealth.org).

Purpose. The epidemiology of acute post-operative pain is reviewed. Data from retrospective studies of the effectiveness of post-operative pain treatment are summarized. The impact of undertreatment of post-operative pain is discussed. Efficacy, safety, and the potential for error associated with intramuscular, intravenous, and epidural modes of analgesia are reviewed. Summary. Seventy-three million patients undergo surgical procedures each year in the United States. Of these, 80% experience acute post-operative pain, and approximately 20% experience severe pain. Clinical, psychologic, and institutional consequences may arise from inadequate pain management. There is strong evidence that the intermittent intramuscular administration of opioids results in higher rates of both moderate-to-severe and severe pain. Conclusion. There exists a need for interventions that are patient focused and characterized by ease of use, improved adverse-effect and safety profiles, and manageable overall costs. Index terms: Analgesics and antipyretics; Costs; Drug administration routes; Economics; Epidemiology; Errors, medication; Opiates; Pain; Surgery; Toxicity