Pulmonary oedema and haemoptysis induced by strenuous swimming

Abstract

Hospitals responding to questionnaire that had an acute pain service by region No (%) of Region hospitals East Anglia 5 (62) Mersey 3 (37) North East Thames 9 (45) North West Thames 8 (44) North West 7 (50) Northem 5 (35) Oxford 5 (62) South East Thames 5 (33) South West Thames 6 (50) South West 7 (58) Trent 4 (28) West Midlands 5 (28) Wessex 4 (44) Yorkshire 7 (50) Wales 6 (43) Scotland 7 (41) Northern Ireland 4 (67)only 18 hospitals and the relative rarity of specific "pain nurses" and dedicated medical sessions gives concern as to the permanence of these services.Pain, Discomfort and Palliative Care, a Welsh Health Planning Forum document, gives clear advice and targets for both the purchaser and the provider- including the establishment of an acute pain service in all hospitals in Wales by 1995.4However, at the time of this survey, fewer than 50% of responding units in Wales had achieved this.Although patient controlled analgesia and epidural opioid administration were available in most units, in many units such techniques were seldom used.Inter- mittent intramuscular injection of opioid is still widely used in a large number of hospitals.This may.not necessarily be detrimental; good levels of analgesia can be achieved, as has been shown by Gould et al.5 It is to be hoped that an increasing number of hospitals will establish acute pain services.To this end, continued pressure should be placed on the purchaser to demand optimal acute pain management from their provider units-and be prepared to pay for it.