Acute pain in African hospitals is far more common than previously documented, with two-thirds of admitted patients affected, according to a new University of Cape Town (UCT) study. Researchers found that 67.9% of adults experienced some level of pain, while 14.4% - roughly one in seven - reported severe pain, defined as a score of seven or more out of 10. The findings offer the first large-scale evidence of this burden across the continent.
The study tracked 19,438 patients in 180 hospitals across 22 African countries between September and December 2023. Researchers then followed each patient for seven days to record whether they survived or died in hospital. The results appear in the journal PAIN.
How Widespread Is Acute Pain in African Hospitals?
The severity breakdown was stark. About one-third of patients reported no pain, while 28% reported mild pain, 25.4% moderate pain, and 14.4% severe pain. The median pain score across all patients was three out of 10.
Pain was especially common after trauma. More than eight in 10 trauma patients (84.1%) experienced pain, and 20.3% reported severe pain. By contrast, among patients admitted with non-communicable diseases, 62.6% experienced pain and 12.5% reported severe pain.
Ward setting also mattered. In surgical wards, 16.2% reported severe pain, compared with 11.1% in medical wards. Meanwhile, high-care units recorded one of the highest severe-pain levels at 19.3%, against 14% in general wards. Notably, researchers found no meaningful difference in pain severity between men and women.
Severe Pain Linked to Higher Death Risk
A different pattern emerged when researchers examined deaths. After adjusting for other factors, increasing pain severity was associated with higher odds of dying in hospital within seven days. Patients with severe pain were therefore more likely to die within that window than those without it.
However, the researchers cautioned against reading this as cause and effect. Because the study was observational, it cannot establish causation. Severe pain may instead signal an underlying illness or injury that makes a patient more vulnerable.
Crucially, the study did not record which pain medicines or treatments patients received. As a result, the team could not judge whether particular pain-relief approaches reduced pain or affected survival. Dr Gillian Bedwell, the UCT postdoctoral fellow who led the study, said further work was needed to determine whether pain is a warning sign, a contributor to poor outcomes, or both.
Bedwell also noted how little large-scale data exists on the issue. Previous estimates have largely come from high-income countries, leaving a gap in understanding. Yet the African burden has been similar in those settings, despite far tighter health-care resources.
Implications for Hospital Groups and Medical Schemes
The scale of acute pain in African hospitals carries practical weight for the Southern African sector. Poorly managed pain can disrupt sleep, movement and rehabilitation, and has been linked to delayed recovery. Consequently, it can extend length of stay and raise demands on providers, caregivers and health systems.
For hospital groups, effective pain assessment becomes a measurable marker of care quality. Medical schemes, meanwhile, have a direct interest in shorter recoveries and fewer complications. The study drew on patients from South Africa, Botswana, Lesotho, Namibia and others, giving the findings clear regional relevance.
Analysis
The research reframes acute pain as a health-systems issue, not merely a symptom for patients to endure. For Southern African funders and providers, the mortality signal - however cautious - makes routine pain measurement a defensible investment rather than an optional extra.
Hospital groups that build pain protocols into perioperative and trauma pathways may see gains in both outcomes and cost. As the UCT team turns to how pain is actually managed on the ground, the sector should expect scrutiny of the gap between recorded pain and treatment delivered.
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