A 61-year-old academic in London has written about the amount of pain, totally unexpected, that he suffered after a hernia operation. Is this usual?

The amount of pain that patients suffer after surgery and during the recovery period varies enormously. It is impossible to predict which patients will have more pain than average and difficult to estimate the amount any particular operation will induce. What is certain is that effective pain management is an important, but undertreated, aspect of post-operative care. One survey published in the European Journal of Anaesthesiology found that one in four patients suffered post-operative pain in his or her hospital stay.

Severe pain is more than an inconvenience as it may prevent patients moving around, thereby increasing their vulnerability to deep vein thromboses and pulmonary emboli. It may limit deep breathing so that pulmonary congestion and infection are more likely and it may turn simple physiological tasks such as going to the loo into dreaded events. Excessive pain delays recovery and causes stress.

The standard method of dealing with pain that cannot be alleviated by pills is to attach someone to a patient-controlled pump that delivers intravenous drugs. Pumps are notoriously unreliable and require regular staff care. The pump’s intravenous lead is one route by which a patient may acquire antibiotic-resistant bacteria.

Janssen-Cilag has introduced a means of giving fentanyl, an opioid analgesic, through the skin by means of a needle-free device. It’s an adhesive card known as Ionsys that sticks to the skin of the upper arm or chest. When a patient presses a button attached to a tiny battery on the card twice the fentanyl begins to seep through the skin and into the circulation.

These cards offer an alternative to the patient-controlled pump. Professor Richard Langford, a consultant in anaesthesia and pain relief, has been testing Ionsys delivery of fentanyl for a year. He has found that it is a virtually foolproof way of dispensing ionised fentanyl.

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