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[Postoperative pain as the fifth vital parameter].

INTRODUCTION
Acute postoperative pain and its therapy is a great challenge for all health-care providers in operative medicine today. Despite development of new analgesic drugs and different therapeutic modalities in pain treatment, acute postoperative pain represents a negative experience for many surgical patients.


MATERIAL AND METHODS
By reviewing relevant medical articles on this topic, we tried to find answers on the reasons why many surgical patients have pain in the postoperative period despite implementation of modern and powerful analgesic therapy like patient-controlled analgesia (PCA), spinal/epidural opioids and regional analgesia.


RESULTS
The reasons of inefficacy of many analgesic therapeutic methods are multiple. One of them is the attitude of patients and healthcare workers to pain. Many of them consider pain is a natural and physiological consequence of different diseases and pathological conditions and moderate to severe pain is considered as acceptable consequence of surgery. Another important factor contributing to undertreatment is that pain is invisible in most hospital wards: severity of pain is not assessed, and patients are reluctant to "complain." Unless severity of pain is assessed on a routine basis, pain cannot be effectively treated. Thus, one of the most important changes in the process of improving the efficacy of pain treatment is to introduce pain assessment as the fifth vital sign in addition to the traditional four vital signs (temperature, pulse, blood pressure and respiratory rate).


DISCUSSION
Introduction of the "fifth vital parameter" would solve many problems in postoperative pain therapy, because healthcare workers take vital signs very seriously both for monitoring and treatment. By frequent measuement and registration of pain intensity and by organization of teams for treatment of postoperative pain, analgesic therapy would be more efficient, and whole therapy of surgical patients would be more qualitative. Undertreatment of pain can have very serious consequences; delayed improvement, change of immune system, changed answer to stress, appearance of vegetative symptoms and possibility of permanent changes in peripheral and central nervous system resulting in chronic pain syndrome. These effects are very harmful, changing quality of life of the whole family because the treatment of chronic pain syndrome is very difficult and expensive.


CONCLUSION
Anesthesiologists have a central role in perioperative treatment of surgical patients (from the preoperative preparation through anesthesia and intraoperative monitoring to postoperative treatment and monitoring at the department of the intensive care and at the department of postanesthetic care). Due to abovementioned and familiarity with many therapeutic modalities, like spinal/epidural application of analgesics, regional anesthesia/analgesia many clinicians and pain specialists consider anesthesiologists are those who can organize and supervise teams for acute postoperative pain services.