International Journal of Medical Discoveries

Background: Pain remains one of the primary reasons why people present to the hospital worldwide. Despite several initiatives towards promoting effective pain management, pain management in middle- and low- income countries continue to be inadequate due to a knowledge gap and other institutional barriers. Objective: This study evaluated the impact of a multidisciplinary pain management training program aimed to improve awareness and implementation of pain as the fifth vital sign, and opioid utilisation in a tertiary hospital in Nigeria. Methods: A Pain management training programme was conducted over a 12-month period at Nnamdi Azikiwe Teaching Hospital, Nnewi, Nigeria, involving 840 healthcare professionals across multiple disciplines. Following the training, the pain assessment tool (Numerical Rating Scale: NRS assessment) was incorporated into the routine vital sign assessment after management approval. Compliance with pain assessment was evaluated twice monthly through patient record reviews across selected wards. Opioid utilisation before and after the intervention was also assessed. Results: There was an improvement in pain assessment compliance from the first to the second quarter across all wards, rising from 69% to 87% in the male surgical ward, 66% to 85% in the female surgical ward, 69% to 89% in the postnatal ward, and 43% to 68% in the Accident and Emergency unit. Although a decline was observed in subsequent quarters, overall compliance remained higher than the baseline values. Opioid utilisation increased following the intervention, including the introduction of stronger opioids such as morphine and fentanyl. Morphine was the most frequently prescribed opioid, with pain clinics accounting for the highest proportion of such prescriptions (20%). Conclusion: The pain management training, supported by institutional policy change, improved the implementation of pain management strategies and improved access to appropriate opioid analgesics. The importance of multidisciplinary training and organisational support in improving pain care in resource-limited settings is highlighted by these findings.