Building an Acute Pain Service: Why It Matters in Indian Hospitals

An acute pain service is not a machine or a drug — it is an organised system: someone responsible for pain, a protocol, regular measurement, and a route to escalate when treatment fails. Hospitals that build one see faster mobilisation, fewer pulmonary complications, shorter stays and less persistent post-surgical pain.

The five essential components

• A named lead physician and trained nursing champions on each ward
• Pain scored and charted as a vital sign, at rest and on movement
• Written multimodal protocols by surgery type, with fixed-schedule analgesia
• Clear escalation criteria and a rescue plan available around the clock
• Regular audit of pain scores, side effects and patient satisfaction

Nursing empowerment is the pivot

Most delays in relieving pain occur while waiting for a doctor to authorise a dose that was predictable hours earlier. Standing orders with clear limits allow trained nurses to act immediately and safely.

Practical realities in Indian hospitals

Resources vary, and protocols must be written for the staffing and drug availability that actually exist. Regional and neuraxial techniques deliver excellent value where infusion pumps are limited. Opioid documentation requirements should be planned into the workflow rather than treated as an obstacle. Patient and family education in the local language materially improves adherence.

Measure to improve

Start with one audit: the proportion of patients with a pain score above 4 on the first post-operative day. Publish it monthly. Nothing changes clinical behaviour faster than a number the whole team can see.

Building such a service at a high-volume cancer centre taught me that the system, not the drug, determines whether patients are comfortable.