ISSN: 1859 - 2872
A systematic review of healthcare providers’ knowledge, attitudes, and practices in postoperative pain management
Main Article Content
Keywords
Knowledge, attitudes, and practices, pain management, postoperative pain.
Abstract
Objective: This systematic review seeks to consolidate the existing knowledge of healthcare providers' knowledge, attitudes, and practices about postoperative pain management, identify contributing factors and existing gaps, and propose directions to improve the quality of postoperative care. Subject and method: A systematic search of PubMed was conducted up to December 31, 2024, using MeSH terms and synonyms related to “knowledge,” “attitude,” “practice,” “postoperative pain,” and “healthcare professional.” Studies were included if they quantitatively assessed KAP in postoperative pain management and were published in English. Result: Out of 667 articles screened, 37 studies met the inclusion criteria. Findings revealed marked differences in KAP across countries Globally, knowledge remained limited, with mean scores frequently falling below the 80% benchmark. Significant gaps were identified in opioid pharmacology, pain assessment principles, and multimodal analgesia. Attitudes were often negative or overly cautious, influenced by “opiophobia,” and lack of trust in patients’ self-report pain. Practices showed inconsistent use of pain assessment tools, and a substantial gap persisted between awareness and implementation; multimodal analgesia remained underutulized. Key barriers included limited experience and training in pain management, absence of clinical guidelines, heavy workloads, staff shortages, and poor interdisciplinary collaboration. Conclusion: This review provides a global overview of healthcare professionals’ KAP in postoperative pain management, highlighting current gaps and identifying individual, organizational, and systemic factors influencing pain control. The findings underscore the need for standardized training programs and clinical guidelines to enhance postoperative pain management quality worldwide.
Article Details
References
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2. Adams SM, Varaei S and Jalalinia F (2020) Nurses' Knowledge and Attitude towards Postoperative Pain Management in Ghana. Pain Res Manag: 4893707.
3. Amena N, Dechasa A, Kurke A et al (2024) Postoperative pain management practice and associated factors among nurses working at public hospitals, in Oromia region, Ethiopia, 2021: An institution-based cross-sectional study. BMJ Open 14(11): 080252.
4. Belay MZ and Yirdaw LT (2022) Management of postoperative pain among health professionals working in governmental hospitals in South Wollo Zone, Northeast Ethiopia. Prospective cross sectional study. Ann Med Surg (Lond) 80: 104148.
5. Bird A and Wallis M (2002) Nursing knowledge and assessment skills in the management of patients receiving analgesia via epidural infusion. J Adv Nurs 40(5): 522-531.
6. Chapman PJ, Ganendran A, Scott RJ and Basford KE (1987) Attitudes and knowledge of nursing staff in relation to management of postoperative pain. Aust N Z J Surg 57(7): 447-50.
7. Chatchumni M, Namvongprom A, Eriksson H, and Mazaheri M (2016) Thai Nurses' experiences of post-operative pain assessment and its' influence on pain management decisions. BMC Nurs 15: 12.
8. Chen YR, Chen CC, Wu WW et al (2024) Nurses' knowledge of and attitude toward postoperative patient-controlled analgesia (PCA) and the associated factors. BMC Nurs 23(1): 21.
9. Coluzzi F, Savoia G, Paoletti F et al (2009) Postoperative pain survey in Italy (POPSI): A snapshot of current national practices. Minerva Anestesiol 75(11): 622-31.
10. Coulling S (2005) Nurses' and doctors' knowledge of pain after surgery. Nurs Stand 19(34): 41-49.
11. Demir ET and Erbas M (2022) Anaesthesiologist's Attitude and Behavior Toward Postoperative Pain Management in Turkey. Turk J Anaesthesiol Reanim 50(1): 37-43.
12. Dessie M, Asichale A, Belayneh T et al (2019) Knowledge and Attitudes of Ethiopian Nursing Staff Regarding Post-Operative Pain Management: A Cross-Sectional Multicenter Study. Patient Relat Outcome Meas 10: 395-403.
13. Dongara AR, Shah SN, Nimbalkar SM et al (2015) Knowledge of and Attitudes Regarding Postoperative Pain among the Pediatric Cardiac Nursing Staff: An Indian Experience. Pain Manag Nurs 16(3): 314-20.
14. Francis L and Fitzpatrick JJ (2013) Postoperative pain: nurses' knowledge and patients' experiences. Pain Manag Nurs 14(4): 351-357.
15. Gan TJ (2017) Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res 10: 2287-2298.
16. Gan TJ, Epstein RS, Leone-Perkins ML et al (2018) Practice Patterns and Treatment Challenges in Acute Postoperative Pain Management: A Survey of Practicing Physicians. Pain Ther 7(2): 205-216.
17. He HG, Jahja R, Lee TL et al (2010) Nurses' use of non-pharmacological methods in children's postoperative pain management: Educational intervention study. J Adv Nurs 66(11): 2398-409.
18. Ismail A, Forgeron P, Polomeno V et al (2017) Pain Management Practice and Guidelines in Jordanian Pediatric Intensive Care Units. Pain Manag Nurs 19(2): 195-203.
19. Kang MR and Kwon YJ (2022) Nurses' knowledge and attitudes toward patient-controlled analgesia for postoperative pain control in a tertiary hospital in South Korea. BMC Nurs 21(1): 319.
20. Khatib SK, Razvi SS, Kulkarni SS and Parab S (2017) A multicentre survey of the current acute post-operative pain management practices in tertiary care teaching hospitals in Maharashtra. Indian J Anaesth 61(3): 215-224.
21. Kiekkas P, Gardeli P, Bakalis N et al (2015) Predictors of nurses' knowledge and attitudes toward postoperative pain in Greece. Pain Manag Nurs 16(1): 2-10.
22. Liu Y, Xiao S, Yang H et al (2023) Postoperative pain-related outcomes and perioperative pain management in China: A population-based study. Lancet Reg Health West Pac 39: 100822.
23. Mackintosh C and Bowles S (2000) The effect of an acute pain service on nurses' knowledge and beliefs about post-operative pain. J Clin Nurs 9(1): 119-26.
24. Mackova Porter D, Al Harbi M, Tawfeeq NA and Pokorna A (2022) Awareness of general nurses in management of postoperative pain through patient controlled analgesia - Comparison among the Czech Republic and the Kingdom of Saudi Arabia. Saudi J Anaesth 16(1): 10-16.
25. McNamara MC, Harmon D and Saunders J (2012) Effect of education on knowledge, skills and attitudes around pain. Br J Nurs 21(16): 958, 960-4.
26. Mędrzycka-Dąbrowska W, Dąbrowski S, Gutysz-Wojnicka A et al (2017) Nurses' Knowledge and Barriers Regarding Pain Management. J Perianesth Nurs 33(5): 715-726.
27. Menlah A, Garti I, Amoo SA et al (2018) Knowledge, Attitudes, and Practices of Postoperative Pain Management by Nurses in Selected District Hospitals in Ghana. SAGE Open Nurs 4: 2377960818790383.
28. Negash TT, Belete KG, Tlilaye W et al (2022) Knowledge, attitudes and practices of health professionals towards postoperative pain management at a referral hospital in Ethiopia. Ann Med Surg (Lond) 73: 103167.
29. Nyirigira G, Wilson RA, VanDenKerkhof EG et al (2018) Barriers and facilitators to postoperative pain management in Rwanda from the perspective of health care providers: A contextualization of the theory of planned behavior. Can J Pain 2(1): 87-102.
30. Park R, Mohiuddin M, Arellano R et al (2023) Prevalence of postoperative pain after hospital discharge: systematic review and meta-analysis. Pain Rep 8(3): 1075.
31. Rognstad MK, Fredheim OM, Johannessen TE et al (2012) Attitudes, beliefs and self-reported competence about postoperative pain among physicians and nurses working on surgical wards. Scand J Caring Sci 26(3): 545-52.
32. Samara H, O'Hara L, and Singh K (2024) Nurses' Knowledge and Attitudes about Adult Post-Operative Pain Assessment and Management: Cross Sectional Study in Qatar. Nurs Rep 14(3): 2061-2071.
33. Smeland AH, Twycross A, Lundeberg S, and Rustoen T (2018) Nurses' Knowledge, Attitudes and Clinical Practice in Pediatric Postoperative Pain Management. Pain Manag Nurs 19(6): 585-598.
34. Taylor RS, Ullrich K, Regan S et al (2013) The impact of early postoperative pain on health-related quality of life. Pain Pract. 13(7): 515-523.
35. Teshome ZB, Aychew Y, Mitiku W, and Guta B (2022) Level of attitude, knowledge and practice of nurses toward postoperative pain management, cross-sectional study. Ann Med Surg (Lond) 84: 104902.
36. Tomaszek L and Debska G (2018) Knowledge, compliance with good clinical practices and barriers to effective control of postoperative pain among nurses from hospitals with and without a "Hospital without Pain" certificate. J Clin Nurs 27(7-8): 1641-1652.
37. van Dijk JF, Schuurmans MJ, Alblas EE, Kalkman CJ, van Wijck AJ et al (2017) Postoperative pain: knowledge and beliefs of patients and nurses. J Clin Nurs 26(21-22): 3500-3510.
38. Vu PH, Tran DV, Le YT et al (2020) Postoperative Pain Management among Registered Nurses in a Vietnamese Hospital. ScientificWorldJournal. 2020 Aug 11;2020:6829153.
39. Youngcharoen P and Aree-Ue S (2022) A cross-sectional study of factors associated with nurses' postoperative pain management practices for older patients. Nurs Open 10(1): 90-98.
40. Youngcharoen P and Piyakhachornrot C (2024) Online Learning to Improve Nurses' Knowledge, Attitudes, and Self-Efficacy About Managing Postoperative Pain in Older Adults. Pain Manag Nurs 25(3): 249-257.
41. Youngcharoen P, Vincent C, Park CG et al (2016) Nurses' Pain Management for Hospitalized Elderly Patients With Postoperative Pain. West J Nurs Res 38(11): 1409-1432.
42. Zachodnik J, Andersen JH, and Geisler A (2019) Barriers in pain treatment in the emergency and surgical department. Dan Med J 66(2).
2. Adams SM, Varaei S and Jalalinia F (2020) Nurses' Knowledge and Attitude towards Postoperative Pain Management in Ghana. Pain Res Manag: 4893707.
3. Amena N, Dechasa A, Kurke A et al (2024) Postoperative pain management practice and associated factors among nurses working at public hospitals, in Oromia region, Ethiopia, 2021: An institution-based cross-sectional study. BMJ Open 14(11): 080252.
4. Belay MZ and Yirdaw LT (2022) Management of postoperative pain among health professionals working in governmental hospitals in South Wollo Zone, Northeast Ethiopia. Prospective cross sectional study. Ann Med Surg (Lond) 80: 104148.
5. Bird A and Wallis M (2002) Nursing knowledge and assessment skills in the management of patients receiving analgesia via epidural infusion. J Adv Nurs 40(5): 522-531.
6. Chapman PJ, Ganendran A, Scott RJ and Basford KE (1987) Attitudes and knowledge of nursing staff in relation to management of postoperative pain. Aust N Z J Surg 57(7): 447-50.
7. Chatchumni M, Namvongprom A, Eriksson H, and Mazaheri M (2016) Thai Nurses' experiences of post-operative pain assessment and its' influence on pain management decisions. BMC Nurs 15: 12.
8. Chen YR, Chen CC, Wu WW et al (2024) Nurses' knowledge of and attitude toward postoperative patient-controlled analgesia (PCA) and the associated factors. BMC Nurs 23(1): 21.
9. Coluzzi F, Savoia G, Paoletti F et al (2009) Postoperative pain survey in Italy (POPSI): A snapshot of current national practices. Minerva Anestesiol 75(11): 622-31.
10. Coulling S (2005) Nurses' and doctors' knowledge of pain after surgery. Nurs Stand 19(34): 41-49.
11. Demir ET and Erbas M (2022) Anaesthesiologist's Attitude and Behavior Toward Postoperative Pain Management in Turkey. Turk J Anaesthesiol Reanim 50(1): 37-43.
12. Dessie M, Asichale A, Belayneh T et al (2019) Knowledge and Attitudes of Ethiopian Nursing Staff Regarding Post-Operative Pain Management: A Cross-Sectional Multicenter Study. Patient Relat Outcome Meas 10: 395-403.
13. Dongara AR, Shah SN, Nimbalkar SM et al (2015) Knowledge of and Attitudes Regarding Postoperative Pain among the Pediatric Cardiac Nursing Staff: An Indian Experience. Pain Manag Nurs 16(3): 314-20.
14. Francis L and Fitzpatrick JJ (2013) Postoperative pain: nurses' knowledge and patients' experiences. Pain Manag Nurs 14(4): 351-357.
15. Gan TJ (2017) Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res 10: 2287-2298.
16. Gan TJ, Epstein RS, Leone-Perkins ML et al (2018) Practice Patterns and Treatment Challenges in Acute Postoperative Pain Management: A Survey of Practicing Physicians. Pain Ther 7(2): 205-216.
17. He HG, Jahja R, Lee TL et al (2010) Nurses' use of non-pharmacological methods in children's postoperative pain management: Educational intervention study. J Adv Nurs 66(11): 2398-409.
18. Ismail A, Forgeron P, Polomeno V et al (2017) Pain Management Practice and Guidelines in Jordanian Pediatric Intensive Care Units. Pain Manag Nurs 19(2): 195-203.
19. Kang MR and Kwon YJ (2022) Nurses' knowledge and attitudes toward patient-controlled analgesia for postoperative pain control in a tertiary hospital in South Korea. BMC Nurs 21(1): 319.
20. Khatib SK, Razvi SS, Kulkarni SS and Parab S (2017) A multicentre survey of the current acute post-operative pain management practices in tertiary care teaching hospitals in Maharashtra. Indian J Anaesth 61(3): 215-224.
21. Kiekkas P, Gardeli P, Bakalis N et al (2015) Predictors of nurses' knowledge and attitudes toward postoperative pain in Greece. Pain Manag Nurs 16(1): 2-10.
22. Liu Y, Xiao S, Yang H et al (2023) Postoperative pain-related outcomes and perioperative pain management in China: A population-based study. Lancet Reg Health West Pac 39: 100822.
23. Mackintosh C and Bowles S (2000) The effect of an acute pain service on nurses' knowledge and beliefs about post-operative pain. J Clin Nurs 9(1): 119-26.
24. Mackova Porter D, Al Harbi M, Tawfeeq NA and Pokorna A (2022) Awareness of general nurses in management of postoperative pain through patient controlled analgesia - Comparison among the Czech Republic and the Kingdom of Saudi Arabia. Saudi J Anaesth 16(1): 10-16.
25. McNamara MC, Harmon D and Saunders J (2012) Effect of education on knowledge, skills and attitudes around pain. Br J Nurs 21(16): 958, 960-4.
26. Mędrzycka-Dąbrowska W, Dąbrowski S, Gutysz-Wojnicka A et al (2017) Nurses' Knowledge and Barriers Regarding Pain Management. J Perianesth Nurs 33(5): 715-726.
27. Menlah A, Garti I, Amoo SA et al (2018) Knowledge, Attitudes, and Practices of Postoperative Pain Management by Nurses in Selected District Hospitals in Ghana. SAGE Open Nurs 4: 2377960818790383.
28. Negash TT, Belete KG, Tlilaye W et al (2022) Knowledge, attitudes and practices of health professionals towards postoperative pain management at a referral hospital in Ethiopia. Ann Med Surg (Lond) 73: 103167.
29. Nyirigira G, Wilson RA, VanDenKerkhof EG et al (2018) Barriers and facilitators to postoperative pain management in Rwanda from the perspective of health care providers: A contextualization of the theory of planned behavior. Can J Pain 2(1): 87-102.
30. Park R, Mohiuddin M, Arellano R et al (2023) Prevalence of postoperative pain after hospital discharge: systematic review and meta-analysis. Pain Rep 8(3): 1075.
31. Rognstad MK, Fredheim OM, Johannessen TE et al (2012) Attitudes, beliefs and self-reported competence about postoperative pain among physicians and nurses working on surgical wards. Scand J Caring Sci 26(3): 545-52.
32. Samara H, O'Hara L, and Singh K (2024) Nurses' Knowledge and Attitudes about Adult Post-Operative Pain Assessment and Management: Cross Sectional Study in Qatar. Nurs Rep 14(3): 2061-2071.
33. Smeland AH, Twycross A, Lundeberg S, and Rustoen T (2018) Nurses' Knowledge, Attitudes and Clinical Practice in Pediatric Postoperative Pain Management. Pain Manag Nurs 19(6): 585-598.
34. Taylor RS, Ullrich K, Regan S et al (2013) The impact of early postoperative pain on health-related quality of life. Pain Pract. 13(7): 515-523.
35. Teshome ZB, Aychew Y, Mitiku W, and Guta B (2022) Level of attitude, knowledge and practice of nurses toward postoperative pain management, cross-sectional study. Ann Med Surg (Lond) 84: 104902.
36. Tomaszek L and Debska G (2018) Knowledge, compliance with good clinical practices and barriers to effective control of postoperative pain among nurses from hospitals with and without a "Hospital without Pain" certificate. J Clin Nurs 27(7-8): 1641-1652.
37. van Dijk JF, Schuurmans MJ, Alblas EE, Kalkman CJ, van Wijck AJ et al (2017) Postoperative pain: knowledge and beliefs of patients and nurses. J Clin Nurs 26(21-22): 3500-3510.
38. Vu PH, Tran DV, Le YT et al (2020) Postoperative Pain Management among Registered Nurses in a Vietnamese Hospital. ScientificWorldJournal. 2020 Aug 11;2020:6829153.
39. Youngcharoen P and Aree-Ue S (2022) A cross-sectional study of factors associated with nurses' postoperative pain management practices for older patients. Nurs Open 10(1): 90-98.
40. Youngcharoen P and Piyakhachornrot C (2024) Online Learning to Improve Nurses' Knowledge, Attitudes, and Self-Efficacy About Managing Postoperative Pain in Older Adults. Pain Manag Nurs 25(3): 249-257.
41. Youngcharoen P, Vincent C, Park CG et al (2016) Nurses' Pain Management for Hospitalized Elderly Patients With Postoperative Pain. West J Nurs Res 38(11): 1409-1432.
42. Zachodnik J, Andersen JH, and Geisler A (2019) Barriers in pain treatment in the emergency and surgical department. Dan Med J 66(2).
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Published
Oct 24, 2025
Section
Articles
How to Cite
HàN. T., HuyP. V., MỹL. T., AnhL. T. P., HươngN. T. L., HạnhN. T. H., TrangT. T. T., & SơnN. T. (2025). A systematic review of healthcare providers’ knowledge, attitudes, and practices in postoperative pain management. Tạp Chí Y Dược lâm sàng 108, 20. https://doi.org/10.52389/ydls.v20i0.2843