A University of Cape Town-led study has revealed that treatment for pain is erratic and patchy – not just in South African hospitals but in facilities continent-wide, reports TimesLIVE.
Findings showed that two-thirds of adults admitted to hospitals across Africa experience pain and one in seven suffers severe pain. South Africa was one of the biggest contributors to the research, accounting for more than 10% of the 19 438 patients studied across 180 hospitals in 22 African countries.
The researchers said a total of 67.9% of the adults admitted to hospitals across Africa experienced some level of pain, while 14.4% reported severe pain, defined as a score of seven or more out of 10.
They had studied 19 438 patients in 180 hospitals across 22 African countries between September and December 2023, and then follow up the patients for seven days to determine whether they survived or died in hospital.
The findings, published in the journal PAIN, provide what the researchers describe as the first large-scale evidence of the burden of acute pain among patients admitted to hospitals in Africa.
About one-third of them reported no pain, while 28% reported mild pain, 25.4% moderate pain and 14.4% severe pain. Pain was particularly common among patients who had been admitted after trauma. More than eight in 10 trauma patients (84.1%) experienced pain, while 20.3% reported severe pain. This was higher than among patients admitted with non-communicable diseases, where 62.6% experienced pain and 12.5% reported severe pain.
Patients in surgical wards also reported more pain than those in medical wards, with 16.2% reporting severe pain compared with 11.1% in medical wards.
High-care units recorded one of the highest levels of severe pain, at 19.3%, compared with 14% in general wards.
The researchers found no meaningful overall difference in pain severity between men and women.
The median pain score among all patients was three out of 10. The researchers also found no evidence that pain severity was associated with whether a patient was classified as critically ill.
However, a different pattern emerged when researchers looked at deaths.
After taking other factors into account, increasing pain severity was associated with increased odds of dying in hospital within seven days. The study found patients with severe pain were more likely to die within seven days than those without severe pain.
The researchers stressed that the finding should not be interpreted to mean severe pain causes death because the study was observational and cannot establish cause and effect. Severe pain could instead be a sign of an underlying illness or injury that makes a patient more vulnerable to poor outcomes.
The study did not record which pain medicines or other treatments patients received. This means the researchers could not determine whether specific pain relief approaches reduced pain or affected patients’ survival chances.
Dr Gillian Bedwell, a postdoctoral fellow in UCT’s African Pain Research Initiative who led the study, said further research was needed to understand the relationship between pain and poor outcomes.
“Further studies are needed to determine whether pain is a warning sign, a contributor to poor clinical outcomes, or both,” she said.
The findings also highlight how little is known about pain among hospital patients in Africa.
“Africa has historically had little large-scale data on pain among hospitalised patients. Previous international estimates have largely come from high-income countries, leaving a major gap in understanding what patients experience in African hospitals,” she said.
The study had aimed to provide an overall picture of pain across African hospitals rather than compare countries, so no separate figure exists for South Africa alone.
Because South Africa and Nigeria contributed such large numbers of patients, the researchers checked whether the two countries were skewing the results.
“When we repeated the analysis without them, the main findings remained essentially unchanged,” she said. “This gives us confidence that the overall results were not simply being driven by the countries that contributed the most patients.”
She added that a study designed specifically for South Africa would be needed to produce a reliable national figure.
The researchers found the burden of pain was similar to levels reported in high-income countries, despite major differences in healthcare resources.
Bedwell said pain should not simply be seen as something patients have to endure while doctors treat the illness or injury that brought them to hospital.
“Acute pain in hospital is sometimes viewed primarily as a symptom to be endured while the underlying illness or injury is treated. But poorly managed acute pain can have broader consequences for patients, their families and health systems.”
For patients, those consequences can extend beyond the immediate discomfort.
The researchers said poorly managed acute pain can affect sleep, movement and rehabilitation and has been linked to delayed recovery and other clinical complications.
Its effects can also continue after a patient leaves hospital, potentially delaying their return to normal activities and work and increasing the demands placed on caregivers and health care services.
“Recognising and managing pain effectively should be a fundamental part of providing high-quality hospital care,” said Bedwell.
The researchers said the next step is to establish how pain is assessed and managed in African hospitals and to understand what prevents patients from receiving effective pain relief.
They also want to identify strategies that could improve pain management in Africa’s hospitals.
For Bedwell, the first step for hospital managers and clinicians is to stop treating pain as simply an unavoidable symptom of illness, injury or surgery and start recognising it as a vital part of a patient’s overall care.
“Pain is complex, and its severity does not always correspond directly to the severity of an injury or illness,” she said.
The study formed part of the African Critical Illness Outcomes Study and was supported by the National Institute for Health and Care Research Global Health Group in Perioperative and Critical Care.
SAMA concern
The South African Medical Association (SAMA) welcomed the research, describing pain as a fundamental part of patient care that should be assessed, treated and reassessed alongside other clinical priorities.
It said pain is already an established part of clinical care, particularly for patients who’ve undergone surgery, suffered trauma or are critically ill, but consistency remains a challenge.
“In busy hospitals, particularly where services are under pressure, pain assessment and reassessment can compete with multiple urgent clinical demands,” SAMA said, but admitted there was “room for improvement”.
“Pain should never be regarded as a secondary issue simply because it is not immediately life-threatening.”
The association pointed out that this is a system-wide problem rather than a lack of care from doctors and nurses, who are often forced to prioritise critically ill patients while managing heavy patient loads and limited resources.
SAMA listed understaffing, heavy workloads, inconsistent access to medicines, limited specialist services and gaps in training among the biggest obstacles.
“Patients should not endure avoidable pain because an under-resourced health system lacks the capacity to provide timely, appropriate care,” it said.
While clinical guidelines, hospital protocols and medicine formularies exist to guide pain treatment, the association acknowledged that implementation and resources varied between facilities. It called for standardised pain-assessment tools and routine reassessment to close the gaps.
“Effective pain management is a fundamental part of safe, quality healthcare, not an optional extra,” it said.
On the study’s finding that patients with severe pain had 27% greater odds of dying in hospital within seven days, SAMA described this as “concerning and warrants further investigation”, while stressing that this finding did not prove that pain causes death, since severe pain may simply be a sign of serious underlying illness or injury.
PainSA, the South African chapter of the International Association for the Study of Pain, has been working to strengthen pain education and universities are increasingly weaving modern pain science into healthcare training.
At UCT, this includes a postgraduate diploma in interdisciplinary pain management, bringing together doctors, nurses, physiotherapists, occupational therapists and psychologists.
Study details
One in seven has severe pain: a point-prevalence study of hospitalised patients across Africa
African Critical Illness Outcomes Study (ACIOS) Investigators: Writing Committee
Gillian Bedwell, Romy Parker, Victoria Madden et al.
Published in Pain in October 2026
Abstract
Acute pain in hospitalised patients is common, yet African data are scarce. We conducted a prospective point-prevalence study of hospitalised adult patients across Africa to determine acute pain prevalence and severity and investigate associations of pain with critical illness and 7-day mortality. On a single day, investigators assessed patients' worst pain in the preceding 24 hours using a 0 to 10 visual-numerical scale and recorded vital signs. Critical illness was defined as ≥1 vital sign out of range, in line with an international consensus definition. In-hospital mortality was assessed at day 7. Data are presented as median [interquartile range], n (%), and odds ratios with 95% confidence intervals. Between September and December 2023, 19,438 patients from 180 hospitals in 22 African nations were included (age 40 [29; 59] years; 10,874 [56%] female). Pain prevalence [95% CI] was 67.9% [67.9-68.5], with 2795 (14.4%) patients reporting severe pain (≥7/10). Pain was more common among patients admitted for emergency or trauma care and in surgical and high-care wards. Pain severity did not differ meaningfully between sexes. There was no evidence of an association between pain severity and critical illness; however, increasing pain severity was associated with a higher likelihood of 7-day mortality. These findings are comparable to data from high-income countries despite substantial differences in healthcare resources, suggesting that acute pain remains a persistent and under-addressed problem globally. This study provides the first large-scale evidence of acute pain burden in African hospitals and lays a foundation for future research aimed at comprehensively characterising in-hospital pain.
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