By JD GLOBAL MEDIA
A large University of Cape Town-led study has highlighted the scale of acute pain among hospital patients across Africa, finding that more than two-thirds of adults admitted to hospitals experienced pain and that about one in seven experienced severe pain.
The research involved 19,438 adult patients treated at 180 hospitals across 22 African countries between September and December 2023. Researchers found that 67.9% of the patients reported some level of pain during the 24 hours preceding assessment, while 14.4% reported severe pain, defined in the study as a pain score of seven or more on a scale of zero to 10.
The findings are particularly significant for South Africa because the country was one of the largest contributors to the research, accounting for more than 10% of the total patients included in the study. However, the researchers caution that the study was designed to establish the broader African burden of acute pain and does not provide a separate national prevalence figure for South Africa.
The research, led by scientists associated with UCT's African Pain Research Initiative, provides one of the largest assessments yet of acute pain among hospitalised adults in Africa.
It also raises questions about how hospitals assess pain, how quickly patients receive appropriate relief and what factors may prevent effective pain management.
Pain Was Widespread Across Hospital Wards
The study found that pain was not restricted to one category of patient or one type of hospital ward.
Patients admitted following trauma had particularly high levels of pain. Among this group, 84.1% experienced pain and 20.3% reported severe pain. Patients receiving surgical care also had a higher burden of pain than those in medical wards. Severe pain was reported by 16.2% of patients in surgical wards, compared with 11.1% in medical wards.
High-care units also recorded a substantial burden, with severe pain reported by 19.3% of patients.
The findings demonstrate that pain can affect patients across different parts of the hospital system, from emergency and trauma care through to surgical and high-care settings.
The researchers found no meaningful overall difference in pain severity between men and women.
The study also found that pain was more common among patients admitted for emergency or trauma care than among patients receiving elective care. Surgical wards had a higher prevalence of any pain than medical wards, while high-care units also recorded higher pain prevalence than general wards.
South Africa Was A Major Contributor
South African hospitals played a significant role in generating the study's evidence.
More than one in every 10 patients included in the research came from South Africa, making the country one of the largest contributors to the dataset.
However, researchers have stressed that the results should not be interpreted as saying that exactly 67.9% of South African hospital patients experience pain.
Dr Gillian Bedwell, the study's lead researcher and a postdoctoral researcher at UCT's African Pain Research Initiative, said the research was intended to provide an overall picture of pain across African hospitals rather than compare individual countries.
Because South Africa and Nigeria contributed relatively large numbers of participants, the researchers conducted an additional analysis excluding those two countries. The main findings remained essentially unchanged, according to Bedwell.
A separate study specifically designed to measure the national burden of hospital pain in South Africa would be required to produce a reliable country-level estimate.
That distinction is important because healthcare systems, hospital resources, patient populations and clinical practices vary significantly between countries.
Severe Pain And The Question Of Mortality
One of the study's most important findings concerned the relationship between pain severity and short-term survival.
Researchers found that increasing pain severity was associated with a greater likelihood of dying in hospital within seven days.
After accounting for other factors, patients experiencing severe pain had 27% greater odds of dying within seven days than patients who reported no pain.
However, the researchers have specifically warned against interpreting this as evidence that pain itself causes death.
The study was observational, meaning it identified an association but could not establish cause and effect.
Severe pain may instead be a warning sign of an underlying illness, injury or complication that also increases a patient's risk of death.
A patient experiencing severe pain after serious trauma, for example, may have a more severe underlying injury than another patient whose pain is less intense.
The researchers therefore say further studies are necessary to determine whether severe pain is primarily a marker of serious illness, contributes independently to poor outcomes, or represents both possibilities.
The published research similarly reports an association between increasing pain severity and seven-day mortality while noting that the study does not establish causality.
The Study Did Not Measure Which Pain Treatments Patients Received
Another important limitation is that the research did not collect detailed information about the pain medicines or other treatments patients received.
As a result, the findings cannot establish whether particular pain-relief strategies were more effective than others or whether differences in treatment contributed to the outcomes observed.
This is an important issue for interpreting the results.
The study demonstrates the prevalence and severity of pain, but it does not provide a direct assessment of the quality of pain treatment in every participating hospital.
The researchers say the next phase of work needs to investigate how hospitals currently assess and manage pain and identify the barriers preventing patients from receiving effective relief.
That research could provide more practical information for hospitals and health authorities seeking to improve patient care.
Why Acute Pain Matters Beyond Immediate Discomfort
Pain is sometimes treated as a secondary symptom while medical teams concentrate on the illness or injury that caused a patient to require hospital care.
The UCT researchers argue that this approach can overlook the wider effects of poorly controlled acute pain.
Pain can interfere with sleep and movement and can make rehabilitation more difficult.
For surgical and trauma patients, difficulty moving because of uncontrolled pain can complicate recovery.
The consequences can also extend beyond the hospital.
Patients who experience prolonged difficulties recovering may take longer to return to normal activities or work, while family members and other caregivers may face additional responsibilities.
The UCT research team says poorly managed acute pain can therefore affect not only individual patients but also families and health systems.
This makes pain management relevant to the wider quality of hospital care rather than simply to the comfort of patients.
A Significant Evidence Gap In Africa
The study addresses a gap that has existed in African healthcare research for years.
Much of the existing large-scale information about acute hospital pain has come from higher-income countries.
That creates difficulties when attempting to understand the experience of patients in African hospitals, where health systems can have different levels of staffing, equipment, medicines and specialist services.
The new research provides a large dataset covering 22 African countries.
Researchers found that the overall burden of acute pain was comparable to estimates from high-income countries despite substantial differences in healthcare resources.
That finding does not mean that hospitals across Africa have identical pain-management systems.
Rather, it indicates that acute pain is a widespread problem that occurs across very different healthcare environments.
The scale of the study gives researchers a stronger foundation for investigating why pain remains common and how hospitals can respond.
Trauma Patients Face Particularly High Burden
The results involving trauma patients stand out.
More than four out of five trauma patients in the study experienced pain, while roughly one in five reported severe pain.
Trauma patients can arrive at hospitals with fractures, wounds, internal injuries and other conditions that naturally produce acute pain.
The findings suggest that emergency and trauma services need effective mechanisms for recognising and responding to pain alongside the assessment of potentially life-threatening injuries.
Pain assessment can also provide clinical information.
Changes in pain intensity may sometimes indicate changes in a patient's condition, although pain alone cannot determine the seriousness of an injury or illness.
The study's findings therefore reinforce the need to treat pain assessment as part of broader clinical monitoring rather than as an issue that can be addressed only after more urgent medical decisions have been made.
Surgical Wards Also Recorded Higher Pain Levels
Surgical patients were another group with a high burden of pain.
The study found that 77.3% of patients in surgical wards experienced some level of pain, compared with 58.6% in medical wards. Severe pain affected 16.2% of surgical patients compared with 11.1% of patients in medical wards.
The difference reflects the nature of many surgical admissions, where patients may experience pain from the underlying condition, the surgical procedure itself or the recovery process.
Effective pain management can be particularly important during rehabilitation because patients may need to move, breathe deeply, participate in physiotherapy or perform other activities during recovery.
The researchers say further work is needed to understand the extent to which these needs are being met in hospitals across the continent.
The Findings Do Not Mean Every Patient Is Receiving Inadequate Care
The study's results should not be interpreted as evidence that hospitals universally fail to manage pain.
The research measured the presence and severity of pain among patients but did not collect sufficient information about individual treatment plans to determine whether particular hospitals were providing inadequate care.
There can also be legitimate clinical reasons why a patient continues to experience pain despite receiving treatment.
Some injuries and diseases can cause severe pain that is difficult to eliminate completely.
The study's purpose was therefore not to identify individual hospitals or blame healthcare workers.
Instead, it establishes the scale of the problem and identifies areas where more research is required.
This distinction is particularly important when translating research findings into healthcare policy.
Researchers Want To Study Current Pain Management
The next phase of work will examine what happens after patients report pain.
Researchers want to understand how pain is assessed in African hospitals, what treatments are available, what prevents patients from receiving effective relief and which approaches could be realistically implemented in different healthcare settings.
That research could identify barriers that extend beyond the availability of medicines.
Staffing levels, training, clinical protocols, documentation practices and the ability to reassess patients may all influence how pain is managed.
Different hospitals may also have different access to specialist pain services.
Understanding those factors would allow interventions to be designed around actual problems rather than assuming that one solution would work everywhere.
Building Better Data For South Africa
The participation of South African hospitals gives researchers a substantial foundation, but the absence of a dedicated national estimate also highlights the need for country-specific research.
South Africa has a large and diverse healthcare system that includes public and private hospitals, urban tertiary centres, regional facilities and district-level services.
A national study could examine how pain prevalence varies between these environments and identify specific challenges affecting different patient groups.
It could also examine the availability of medicines, staffing and specialist pain services.
The current research cannot answer those questions.
What it does provide is evidence that South African researchers can use when designing the next generation of studies.
Pain Management As Part Of Quality Care
The researchers argue that recognising and managing pain should be considered part of high-quality hospital care.
That approach places the patient's experience alongside other clinical priorities.
Pain scoring can provide a structured way of identifying patients who need attention, while repeated assessment can show whether treatment is working.
For patients unable to communicate easily, healthcare teams may need alternative methods of assessment.
The precise approach will depend on the clinical setting, the patient's condition and available resources.
The study does not prescribe one universal model.
Instead, it establishes the need for further research into strategies that are effective and feasible across African hospitals.
Implications For Healthcare Systems
The scale of the findings gives health policymakers another reason to consider pain management as part of broader hospital-quality programmes.
If pain interferes with movement, sleep and rehabilitation, effective management could potentially support recovery and reduce some of the additional demands associated with prolonged illness.
However, the current study does not establish the size of any potential economic savings or prove that improved pain management would reduce hospital costs.
Those questions require separate research.
The immediate evidence is clearer: acute pain is common, severe pain is experienced by a substantial proportion of hospitalised adults, and greater pain severity is associated with higher seven-day mortality.
The association with mortality requires careful interpretation because the study cannot establish that pain itself is responsible for the deaths.
A Foundation For Further Research
The research was conducted as part of the African Critical Illness Outcomes Study and was supported by the National Institute for Health and Care Research Global Health Group in Perioperative and Critical Care.
Its size gives the findings particular significance.
Nearly 20,000 patients were assessed across 180 hospitals, allowing researchers to examine pain across a broad range of healthcare environments.
It also provides a baseline against which future research can be compared.
Future studies could examine whether interventions improve pain assessment, whether particular treatment strategies are more effective in different settings and whether better pain control is associated with improved recovery.
Researchers can also investigate groups that may have different needs, including trauma patients, surgical patients, older adults and patients with complex illnesses.
What The Findings Mean For Patients
For patients, the central message is that pain during hospitalisation is not a rare experience.
The study found that approximately two out of every three adults admitted to participating hospitals reported some pain, while approximately one in seven experienced severe pain.
For healthcare professionals, the findings reinforce the importance of asking patients about pain and taking those reports seriously.
For researchers, the study provides a starting point for understanding the causes and consequences of inadequate pain control.
For health authorities, it highlights an area where additional data may be needed before effective national or regional interventions can be designed.
The Road Ahead For African Hospitals
The UCT-led research has established the scale of acute pain among hospitalised adults across a large part of the African continent.
It found that pain was especially common among trauma patients and that surgical and high-care patients also experienced substantial levels of pain.
South Africa's significant contribution to the study means the country's researchers and healthcare institutions are closely connected to the evidence, although the findings cannot be treated as a national South African prevalence estimate.
The next challenge is moving from measurement to understanding.
Researchers need to determine why some patients receive effective relief while others continue to experience severe pain, what barriers exist within hospitals and which solutions can work in healthcare systems with different resources.
The mortality association will also require further investigation.
The researchers have been clear that severe pain does not necessarily cause death. It may instead indicate that a patient is suffering from a more serious underlying condition. Establishing the direction of that relationship will require additional research.
What the current evidence establishes is that acute pain represents a major and widespread feature of hospital care across Africa.
With 19,438 patients studied across 180 hospitals in 22 countries, the research provides a substantial evidence base for further investigation.
For South Africa, the findings add to the growing body of evidence showing why patient experience, clinical monitoring and recovery should remain central to discussions about hospital quality.
The researchers' next step is to investigate how pain is currently assessed and treated across African hospitals and what can be done to improve care.
That work could ultimately help hospitals develop more consistent approaches to identifying pain, responding to patients and monitoring whether treatment is effective.
The latest study does not provide all those answers.
What it does provide is a clear starting point: pain is common among hospitalised adults, severe pain affects a significant minority, and the problem deserves greater attention in African healthcare research and clinical practice.
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