Patient value of patient-controlled analgesia

Dear Editor,

Millions of patients each year suffer from acute pain as a result of surgery. Recent years have seen an increased awareness on the importance of pain management. Regardless, the management of acute pain remains inadequate, with a substantial proportion of patients continuing to experience intense pain despite the availability of effective treatment. With patient-controlled analgesia (PCA), patients are able to get analgesia on demand without the need of nursing assistance. In Taiwan, which being under the coverage of universal national health insurance, the choice of PCA is at the discretion of the patients with out-of-pocket payment. Although PCA has been used for decades to manage postoperative pain, the cost and value of PCA are not well accepted by patients in Taiwan. As Michael E. Porter¹ wrote, “Achieving high value for patients must become the overarching goal of health care delivery, with value defined as the health outcomes achieved per dollar spent”; it is important to know the value of PCA for patients, especially for those under out-of-pocket payment system. Patients will like to know that PCA can not only offer more efficient postoperative pain management but also promote better quality of life (QOL) compared with non-PCA analgesia.

In order to understand whether PCA may promote long-term QOL in patients, Tai et al² show the different changes of QOL scores among various PCA techniques over time after surgery in their published figure. The statistical significance of difference, however, cannot be found in p value nor in confidence interval among them. In order to provide clear picture for patients, we recommend that their conclusion of PCA on long-term QOL should be more conservative.