New Advances in the Clinical Application of Postoperative Analgesia and Pain Assessment Scales in China

Postoperative pain management is a cornerstone of perioperative medicine, and the accuracy of pain assessment directly determines analgesic efficacy. For decades, Chinese clinical practice has relied heavily on translated versions of foreign pain assessment scales, which often suffer from inadequate cultural adaptation, strong subjectivity, and a unidimensional focus on pain intensity. In 1993, the concept of patient-controlled analgesia (PCA) was introduced in China, followed by widespread clinical adoption by 1998. In 2011, China developed the world's first artificial intelligence PCA (Ai-PCA) pump, with subsequent expert consensus documents published in 2018 and 2024. Leveraging accumulated experience with Ai-PCA, a Chinese research team developed the Smart Patient-Controlled Analgesia Outcome Chinese Pain Assessment Scale (S-CPAS) in 2025. This innovative, intelligent assessment system marks a paradigm shift from subjective, experience-based evaluation to data-driven, multidimensional assessment. The S-CPAS integrates the Pain Comprehensive Index (PCI) – covering pain intensity, functional impacts, adverse reactions, pump operational quality, sedation, and muscle strength – with patient satisfaction scores. It has demonstrated good reliability and validity in multicenter studies. This review systematically examines the past, present, and future of clinical applications of postoperative pain assessment scales in China. We discuss the historical evolution of postoperative analgesia, the limitations of traditional tools, and the core innovations of the S-CPAS in individualization, precision, and intelligence. Future directions include the integration of S-CPAS with the Virtual Pain Unit (VPU) and Acute Pain Service (APS) collaborative management model to enable precision multimodal analgesia (PMA). Other emerging trends are the use of wearable sensors, multimodal physiological monitoring, machine learning-based pain trajectory prediction, and out-of-hospital remote analgesia management. We call for widespread adoption of the S-CPAS-based intelligent assessment platform to promote standardized, high-quality postoperative pain management in China and to contribute to the “Healthy China” strategy.