UCT Study Finds One In Seven Hospital Patients Suffers Severe Pain As Researchers Warn Of Hidden Healthcare Burden

JD GLOBAL MEDIA | SOUTH AFRICA

Published: 21 September 2026

Major UCT-led study reveals widespread pain among hospital patients

A major study led by researchers at the University of Cape Town (UCT) has found that almost seven in every 10 adults admitted to hospitals across Africa experience pain, while about one in seven suffers severe pain.

The findings provide one of the largest examinations yet of acute pain among hospitalised patients on the African continent and raise questions about how effectively pain is being assessed, documented and treated in hospitals.

Researchers analysed information from 19,438 adult patients across 180 hospitals in 22 African countries between September and December 2023. Patients were assessed for the worst pain they had experienced during the previous 24 hours and were followed for seven days to determine whether they survived or died during their hospital stay.

The study found that 67.9% of patients experienced some degree of pain, while 14.4% reported severe pain, defined by researchers as a pain score of seven or more on a scale of 10.

The research was led by UCT's African Pain Research Initiative and forms part of the African Critical Illness Outcomes Study.

Although the research covered multiple African countries, its leadership by a South African university places the findings directly within the country's health-research landscape and highlights the role of South African researchers in examining a problem that affects hospital care across the continent.

Almost 20,000 patients included in the research

The size of the study is one of the reasons researchers regard its findings as significant.

The research involved 19,438 patients, making it considerably larger than many previous studies of hospital pain in African settings.

Participants came from 180 hospitals located in 22 African countries and territories, including South Africa, Botswana, Lesotho, Namibia, Nigeria, Ghana, Kenya, Tanzania, Uganda, Zimbabwe, Mozambique and Morocco.

Researchers assessed patients on a single day during the study period, recording the highest level of pain reported during the previous 24 hours.

Pain was measured using a 0-to-10 numerical scale, allowing patients to indicate the intensity of their symptoms.

A score of seven or higher was classified as severe pain.

The researchers then examined whether pain levels were associated with other clinical characteristics and whether patients survived the following seven days.

This allowed them to investigate not only how common pain was but also whether higher levels of pain were associated with poorer outcomes.

The study has now been published in the medical journal PAIN, adding the findings to the international scientific literature on acute pain in hospitalised patients.

Two-thirds of patients experienced pain

The headline finding is that pain was extremely common.

Almost 68% of hospitalised adults reported some level of pain.

That means approximately two out of every three patients included in the study experienced pain during the period examined.

The researchers divided pain into different levels.

About 28% of patients reported mild pain, while 25.4% reported moderate pain.

A further 14.4% reported severe pain.

Approximately one-third reported no pain.

The median pain score across all patients was three out of 10.

The numbers demonstrate that pain is not limited to a small group of patients undergoing major surgery or suffering traumatic injuries.

It is experienced across different categories of hospital patients and different types of hospital wards.

That has implications for how hospitals approach routine pain assessment.

If pain is present in such a large proportion of patients, researchers argue that identifying and managing it should form a routine part of hospital care rather than being treated as an occasional secondary issue.

Severe pain affected one in seven patients

The most serious finding was the proportion of patients experiencing severe pain.

The study recorded severe pain in 14.4% of participants.

That is approximately one out of every seven hospitalised adults.

Severe pain was defined as a score of seven or higher out of 10.

This level of pain can interfere substantially with a person's ability to move, sleep, communicate and participate in treatment or rehabilitation.

The researchers caution, however, that the presence of severe pain does not automatically mean that a patient has received inadequate treatment.

The study did not collect enough information about the specific pain medicines or other treatments each patient received to determine whether pain-management strategies were effective.

The researchers therefore say further investigation is necessary to understand why such a large proportion of patients experience significant pain and whether treatment practices differ between hospitals and healthcare settings.

Trauma patients experienced particularly high levels of pain

Patients admitted following trauma were among those most likely to experience pain.

The study found that 84.1% of trauma patients reported pain.

More than one in five trauma patients — 20.3% — reported severe pain.

This was substantially higher than the levels recorded among patients admitted with non-communicable diseases.

Among patients admitted for non-communicable diseases, 62.6% experienced pain, while 12.5% experienced severe pain.

The difference is understandable because trauma can involve fractures, wounds, burns, internal injuries and other physical damage.

However, the researchers say the figures demonstrate the importance of effective pain management in emergency and trauma settings.

Patients arriving after serious injuries may already be experiencing intense pain when they reach hospital.

Rapid assessment and appropriate management can therefore become an important part of their initial care.

Surgical wards recorded higher levels of severe pain

The study also found differences between hospital wards.

Patients in surgical wards reported more severe pain than those in medical wards.

In surgical wards, 16.2% of patients reported severe pain.

In medical wards, the figure was 11.1%.

The difference reflects the types of conditions commonly treated in surgical environments.

Patients may be admitted for procedures involving significant tissue injury, operations, postoperative recovery or conditions that require invasive treatment.

Pain can therefore form part of the patient's experience before, during and after surgery.

The findings suggest that surgical services should pay particular attention to pain assessment throughout the patient's hospital journey rather than focusing exclusively on the procedure itself.

High-care patients also experienced significant pain

The research found one of the highest levels of severe pain among patients in high-care units.

Approximately 19.3% of patients in high-care settings reported severe pain.

That compared with 14% in general wards.

High-care patients can have complex or serious medical conditions requiring closer monitoring than patients in ordinary wards.

Some may be recovering from major surgery, trauma or acute illness.

The combination of serious illness and invasive procedures can create multiple potential sources of pain.

The researchers nevertheless found no meaningful overall relationship between pain severity and whether a patient met their definition of critical illness.

That distinction is important.

A patient can experience severe pain without necessarily being classified as critically ill according to vital-sign criteria.

Pain severity was not significantly different between men and women

The researchers also examined whether pain severity differed between men and women.

Overall, they found no meaningful difference in pain severity between the sexes.

The study included 10,874 women, representing approximately 56% of the participants.

The finding is relevant because perceptions of pain can sometimes be influenced by assumptions about how different groups experience or report pain.

The researchers' data did not show a broad difference between male and female patients.

However, the study examined many other variables, including age, medical condition and reason for admission.

The researchers therefore emphasise that pain patterns can vary according to individual circumstances even when there is no overall sex-based difference.

Researchers found an association with seven-day mortality

One of the most important findings concerns the relationship between pain severity and survival.

After adjusting for other factors, the researchers found that increasing pain severity was associated with a higher likelihood of dying in hospital within seven days.

Patients reporting severe pain were more likely to die within seven days than patients who reported no severe pain.

However, the researchers have strongly cautioned against interpreting this finding as proof that severe pain causes death.

The study was observational, meaning it identified an association rather than establishing a cause-and-effect relationship.

Severe pain could instead be a marker of an underlying condition that is itself associated with a higher risk of death.

For example, a patient with a serious injury or advanced illness may experience severe pain because the underlying condition is severe.

In that situation, the pain could be a warning sign of the seriousness of the illness rather than the direct cause of the poor outcome.

The distinction is scientifically important.

The study does not demonstrate that reducing pain would necessarily reduce mortality.

It demonstrates that patients experiencing more severe pain were also more likely to die within the seven-day observation period.

Further research is needed to understand why.

Researchers say pain could be a warning sign

UCT researcher Dr Gillian Bedwell, who led the study, has called for further research into the relationship between pain and poor outcomes.

One of the key questions is whether pain is simply a symptom of a serious underlying illness, whether it contributes to worse outcomes, or whether both factors are involved.

That question cannot be answered by the current study alone.

Researchers would need to examine patients over longer periods and collect more detailed information about their diagnoses, treatment, medication, pain-management strategies and outcomes.

Future research could also compare hospitals and regions to identify whether certain approaches to pain management are associated with better patient experiences or clinical outcomes.

The current study provides a baseline against which future research can be measured.

The research exposes a major gap in African pain data

One of the motivations behind the study was the lack of large-scale information about pain among African hospital patients.

International estimates of hospital pain have often been based on data from high-income countries.

That creates a problem when researchers attempt to understand pain in African hospitals.

Healthcare resources, staffing, treatment practices, patient populations and disease patterns can differ substantially between countries.

Without local data, it is difficult to know whether international estimates accurately describe what African patients experience.

The UCT-led study provides a much larger evidence base.

The findings suggest that the burden of acute pain in African hospitals is substantial and may be comparable to levels reported in wealthier healthcare systems despite major differences in available resources.

Pain management is part of quality healthcare

Pain is sometimes viewed as an unavoidable part of illness or hospital treatment.

A patient undergoing surgery may be expected to experience discomfort.

A person injured in an accident may naturally experience pain.

A patient with a serious disease may have symptoms that cannot immediately be eliminated.

But researchers argue that recognising pain as common does not mean healthcare providers should simply accept uncontrolled pain.

Effective pain management can affect a patient's ability to sleep, move and participate in rehabilitation.

If pain prevents a patient from moving after surgery, for example, it may interfere with recovery.

If pain prevents a patient from sleeping, it can affect their overall wellbeing.

If pain makes it difficult for a patient to participate in physiotherapy or other rehabilitation, recovery can potentially become more difficult.

The researchers therefore argue that pain should be treated as an important component of overall hospital care.

Pain can affect recovery beyond the hospital

The consequences of poorly managed pain may continue after discharge.

A patient who leaves hospital with significant unresolved pain may have difficulty returning to normal activities.

They may require additional medical attention.

They may be unable to work.

They may depend more heavily on relatives or other caregivers.

For families, this can create additional financial and practical pressures.

For healthcare systems, poorly controlled pain can potentially contribute to additional demand for follow-up care.

The researchers therefore describe pain management as an issue that extends beyond the patient's immediate comfort.

It can influence the patient's recovery journey and the resources required after hospital discharge.

South Africa has an important role in the research

The fact that the study was led by researchers at UCT is significant for South Africa's medical research community.

The university's African Pain Research Initiative has contributed to building research capacity around pain and perioperative care.

The current study brought together investigators from multiple African countries and used data from a large network of hospitals.

That makes the research both a scientific achievement and an example of cross-border collaboration.

South African universities and medical researchers frequently participate in international studies involving diseases and health conditions affecting the continent.

This project adds pain management to that research agenda.

It also demonstrates how South African researchers can coordinate large datasets involving hospitals across multiple countries.

The study included patients from South Africa

South Africa was among the countries represented in the research.

The findings therefore have relevance to the country's hospitals, although the study was not designed to provide a national South African prevalence estimate.

That distinction is important.

The 67.9% pain figure represents the combined study population across 22 African countries.

It should not be interpreted as saying that exactly 67.9% of all South African hospital patients experience pain.

Similarly, the 14.4% severe-pain figure represents the overall study population rather than a national South African statistic.

The value for South Africa is that South African institutions and patients formed part of a much broader evidence base examining hospital pain across the continent.

A separate study would be required to establish precise national figures for South Africa.

The study raises questions about routine pain assessment

The findings raise a practical question for hospitals: how consistently is pain being measured?

Pain is subjective.

Unlike blood pressure or body temperature, it cannot simply be determined using one standard physical instrument.

Patients have to communicate what they are experiencing.

That makes systematic assessment important.

A standard numerical scale can help healthcare workers identify whether pain is mild, moderate or severe.

Regular assessment can also allow clinicians to determine whether treatment has improved a patient's symptoms.

If pain is measured only when a patient specifically complains, some patients may remain untreated because they do not communicate their symptoms clearly.

Some may assume pain is unavoidable.

Others may worry about appearing difficult or demanding.

Children, elderly patients or patients with communication difficulties may face additional barriers.

The researchers' findings therefore support the importance of structured pain assessment as part of routine hospital care.

Trauma services may need particular attention

The high pain burden among trauma patients is especially relevant to South Africa.

The country has a significant emergency-care burden involving road crashes, interpersonal violence, falls, workplace injuries and other forms of trauma.

The study's finding that 84.1% of trauma patients experienced pain highlights the need for emergency departments and trauma units to consider pain assessment as an early component of treatment.

Severe pain affected 20.3% of trauma patients in the study.

That means approximately one in five trauma patients experienced pain at the severe level used by researchers.

Pain management in trauma settings can be complicated because healthcare workers must consider the patient's injuries, vital signs, potential need for surgery and other treatment priorities.

Some pain medicines may not be appropriate for every patient.

This makes clinical judgement essential.

The study does not prescribe one universal treatment.

Instead, it highlights the scale of the problem and the need for further research into effective approaches.

Surgical care also requires continuous pain monitoring

The findings from surgical wards have implications for hospitals dealing with both planned and emergency operations.

Pain can occur before an operation, immediately after surgery and during rehabilitation.

Effective postoperative care therefore requires ongoing assessment rather than a single intervention.

Patients may also respond differently to pain medication.

Some may experience inadequate relief, while others may experience side effects.

The ideal treatment depends on the patient's condition, the procedure performed, other medicines being taken and individual medical factors.

The research does not assess which specific treatment is most effective.

Instead, it provides evidence that severe pain remains common among surgical patients and deserves systematic attention.

The study did not measure which medicines patients received

One limitation of the research is particularly important.

The investigators did not record the specific pain medicines or other treatments patients received.

Because of this, the study cannot determine whether a particular pain-management strategy reduced symptoms or influenced survival.

It also cannot identify whether patients experienced severe pain because appropriate treatment was unavailable, because treatment was delayed, because their underlying illness was unusually painful, or for another reason.

Those questions require additional studies.

The researchers have therefore called for research examining how pain is assessed and treated in African hospitals and what barriers prevent patients from receiving effective pain relief.

Healthcare resources remain part of the challenge

Pain management does not happen in isolation.

Hospitals require trained healthcare professionals, medicines, equipment and systems for monitoring patients.

African healthcare systems differ substantially in the resources available to them.

Some hospitals have specialist pain services, anaesthetists and advanced monitoring.

Others may have fewer specialists and limited access to certain medicines or equipment.

The study's finding that pain prevalence was comparable to levels reported in high-income settings despite these resource differences suggests that acute pain is a widespread challenge.

However, the solutions may need to be adapted to the resources available in individual hospitals.

The goal is not necessarily to reproduce the exact model used in a wealthy healthcare system.

Instead, researchers need to identify approaches that are effective, affordable and feasible within African hospitals.

Pain research could influence future hospital policies

The findings could contribute to discussions about hospital quality standards.

If pain is experienced by two-thirds of hospitalised patients, hospitals may need to consider how pain assessment is integrated into routine clinical practice.

This could involve standardised assessment procedures, training for healthcare workers, improved documentation and clearer protocols for responding to severe pain.

Hospitals could also examine whether patients know how to report pain and whether staff have adequate tools to respond.

The researchers' call for further studies suggests that there is still considerable work to be done before specific policy recommendations can be based on the new findings.

But the study provides evidence that pain is sufficiently common to warrant greater attention.

The findings could also improve patient communication

Effective pain management depends partly on communication between patients and healthcare workers.

Patients need to feel able to tell healthcare workers when they are experiencing pain.

Healthcare workers need to ask about pain and take reports seriously.

The numerical pain scale used in the study provides one straightforward way of encouraging communication.

Instead of simply asking whether a patient is in pain, a healthcare worker can ask the patient to rate the intensity.

A patient reporting seven out of 10 can then be assessed differently from someone reporting one or two.

Such tools cannot capture every aspect of pain, but they provide a common language between patients and clinicians.

Not all pain should be treated in the same way

The study also highlights the complexity of pain.

Pain is a symptom rather than a single disease.

The appropriate treatment depends on the cause.

A patient with a broken bone requires a different approach from a patient with postoperative pain.

A person with cancer-related pain may require another treatment strategy.

A patient with an infection may experience pain for reasons that require treatment of the underlying infection.

This is why the researchers do not suggest that every patient should receive the same medication.

Instead, they argue that pain needs to be recognised, assessed and managed according to the patient's clinical circumstances.

The connection between pain and mortality needs more investigation

The association between severe pain and seven-day mortality is one of the findings most likely to generate further research.

The researchers have deliberately avoided saying that pain itself causes death.

That would require a different type of study.

One possibility is that severe pain reflects the severity of the underlying condition.

Another is that severe pain contributes to complications that influence recovery.

A third possibility is that both mechanisms occur simultaneously.

Longitudinal research could help distinguish between these explanations.

Researchers could also investigate whether earlier and more effective pain treatment is associated with better outcomes.

Such studies would need to collect detailed information about diagnoses, treatments, pain levels and patient outcomes.

The findings matter beyond hospital walls

Although the research focuses on hospitalised patients, its implications extend to families and communities.

A patient who experiences prolonged pain may require assistance with everyday activities.

Family members may need to take time away from work to provide care.

A person recovering from surgery or trauma may be unable to return to employment.

The longer recovery takes, the greater the potential social and economic consequences.

Pain therefore has implications beyond medicine.

It can affect household income, caregiving responsibilities and the ability of patients to resume normal life.

Researchers say that poorly managed acute pain can increase demands on patients, families and healthcare services.

Africa needs more local evidence on pain

The researchers describe the current study as a foundation for further work.

The lack of large-scale African data has made it difficult to understand how widespread acute hospital pain is and how it compares across different healthcare settings.

The new dataset begins to close that gap.

However, it also reveals how many questions remain unanswered.

Researchers still need to understand differences between countries, hospitals and clinical specialties.

They need to examine the causes of severe pain.

They need to determine how pain is assessed.

They need to understand which treatments are available.

And they need to investigate whether treatment practices differ according to hospital resources.

UCT study creates a foundation for future research

The research team's next step is expected to involve deeper examination of pain assessment and management.

The scientists want to determine what prevents patients from receiving effective pain relief and which strategies could improve care.

That could involve research into hospital protocols, staff training, medication availability and patient communication.

The findings could eventually help hospitals identify patients at particular risk of uncontrolled pain.

The research may also encourage greater attention to pain as a clinical indicator.

If severe pain consistently proves to be associated with poorer outcomes, it could potentially become an additional signal prompting clinicians to investigate a patient's condition more closely.

But that possibility remains a subject for future research.

A major message for South African healthcare

For South Africa, the UCT-led study sends a clear message about the importance of looking beyond whether a patient is simply admitted, treated and discharged.

Quality healthcare also involves how patients experience treatment.

A patient who survives an operation but spends days in severe uncontrolled pain has not necessarily experienced the best possible recovery.

A trauma patient whose injuries are treated but whose pain remains poorly controlled may face additional difficulties during rehabilitation.

A person with chronic or serious illness may require more comprehensive support than treatment of the underlying disease alone.

Pain management is therefore part of the broader question of patient-centred healthcare.

The study does not suggest that hospitals are failing to treat pain

The findings should not automatically be interpreted as evidence that hospitals are neglecting patients.

The researchers themselves say the study did not collect enough information to determine the effectiveness of individual pain treatments.

A patient may report severe pain despite receiving appropriate treatment because the underlying condition is extremely painful.

Some conditions may not respond completely to available medication.

Others may require repeated intervention.

The study's purpose is to identify the scale of the problem and establish evidence for further investigation.

It does not provide a direct assessment of the performance of individual hospitals or healthcare workers.

That distinction is important when interpreting the results.

The need for better pain research is now clearer

The scale of the findings makes further investigation difficult to ignore.

When 67.9% of hospitalised adults experience pain and 14.4% experience severe pain, pain becomes a major component of the hospital experience.

The high rates among trauma patients and surgical patients reinforce the need for focused research in emergency and perioperative care.

The association between severe pain and seven-day mortality adds another reason for researchers to investigate the issue.

But the most important unanswered question remains whether better pain management can improve clinical outcomes.

The current study cannot answer that.

Future research will have to determine whether pain is primarily a marker of serious illness, a contributor to complications, or both.

A continental study with South African leadership

The research is significant because it combines a large African dataset with leadership from a South African institution.

UCT's involvement demonstrates the country's growing contribution to research addressing major health challenges on the continent.

The study involved hospitals across 22 African countries, creating an unusually broad evidence base.

It also brought together researchers working across different healthcare systems and clinical environments.

Such collaboration is important because African countries face many common health challenges but do not necessarily have identical healthcare systems.

Sharing data can help researchers identify patterns that might remain hidden within individual countries.

What patients and families should understand

The study's findings do not mean that every hospital patient should expect severe pain.

About one-third of participants reported no pain.

Most patients who did experience pain reported mild or moderate levels rather than severe pain.

But patients should still feel able to communicate pain to healthcare workers.

If pain becomes severe, changes suddenly or is accompanied by other worrying symptoms, it is important for patients to tell the healthcare team.

Healthcare workers need accurate information to determine whether symptoms indicate a complication, a progression of the underlying illness or expected recovery-related pain.

The study reinforces the importance of that communication.

The next challenge is turning evidence into better care

The research provides evidence.

The next challenge is determining how hospitals can use it.

Researchers want to understand current pain-management practices and identify practical strategies that can work in African healthcare settings.

Those strategies may include better assessment systems, improved staff training, clearer clinical protocols and research into affordable pain-management approaches.

Any changes would need to account for the different resources available in hospitals.

A solution that works in a well-resourced tertiary hospital may not be directly transferable to a rural facility.

The researchers therefore need to examine what is both effective and realistic.

A problem that has often been hidden in plain sight

Pain is one of the most common symptoms in medicine, but because it is subjective, it can sometimes receive less attention than measurable clinical indicators.

The new UCT-led study shows just how widespread it is among hospital patients.

The finding that nearly seven in 10 adults experienced pain means that pain is not a marginal issue.

It is a central part of the hospital experience for millions of patients.

The finding that approximately one in seven experienced severe pain makes the issue even more significant.

And the association between increasing pain severity and seven-day mortality gives researchers an additional reason to investigate what pain might reveal about a patient's condition.

The road ahead for South African health research

South Africa's role in the study places the country at the forefront of a growing research effort into pain and critical care.

The work could provide a foundation for future studies specifically examining South African hospitals.

Those studies could investigate differences between provinces, urban and rural facilities, public and private hospitals and different clinical specialties.

Researchers could also examine the availability of pain medicines and the training of healthcare professionals in pain assessment.

Such research would help determine whether the patterns identified across Africa are reflected in South African hospitals and where the greatest opportunities for improvement lie.

A new focus on the patient's experience

The central message from the UCT study is that successful healthcare is not only about treating the disease that brought a patient to hospital.

It is also about managing the symptoms and complications that accompany illness and treatment.

Pain can affect sleep.

It can limit movement.

It can interfere with rehabilitation.

It can increase the burden on families.

And it may be associated with poorer outcomes.

The researchers therefore argue that effective pain assessment and management should be regarded as a fundamental component of high-quality hospital care.

What the findings mean

The study does not provide a simple answer to the problem of hospital pain.

It does, however, establish the scale of the issue.

Among 19,438 patients in 180 hospitals across 22 African countries, more than two-thirds experienced pain, while 14.4% experienced severe pain.

Trauma patients recorded particularly high rates, with 84.1% experiencing pain and 20.3% experiencing severe pain.

Surgical wards also recorded higher severe-pain levels than medical wards, while high-care units recorded severe pain in nearly one-fifth of patients.

The researchers found no meaningful overall difference in pain severity between men and women and no evidence that pain severity was directly associated with critical illness as defined by the study.

However, higher pain severity was associated with increased odds of dying in hospital within seven days.

The researchers have stressed that this is an association and not proof that severe pain causes death.

The study also makes clear that there is still limited information about exactly how pain is being treated in African hospitals.

Because the researchers did not record the specific medicines or other interventions received by patients, they cannot say whether particular pain-management approaches improve survival or recovery.

That is now one of the major questions for future research.

A significant moment for African hospital care

The UCT-led research provides a new picture of what many hospital patients experience but which has historically received limited large-scale attention in Africa.

For South Africa, it is also a reminder of the role its universities and researchers can play in addressing health problems that cross national borders.

The study's findings place acute pain alongside other major healthcare priorities that require systematic research, evidence-based treatment and appropriate allocation of resources.

The researchers now want to understand what happens after pain is identified: how hospitals respond, what treatments are available, what barriers exist and which approaches can produce better outcomes.

That work could eventually help hospitals develop more effective ways of identifying patients who need urgent pain management.

For now, the message from the research is clear.

Pain is extremely common among hospitalised patients across Africa, severe pain affects approximately one in seven, and the burden is particularly high among trauma and surgical patients.

The association between severe pain and mortality requires further investigation, but the study has already established that acute pain deserves greater attention in hospital care.

For patients, families and healthcare workers, the findings reinforce an important principle: pain should not simply be accepted as something that must be endured while other medical problems are treated.

It is a clinical symptom that requires assessment, communication and appropriate management.

And with UCT leading one of the largest studies yet conducted on hospital pain in Africa, South African researchers are helping to build the evidence needed to determine how hospitals across the continent can respond more effectively.