Original Article

The Prevalence of Pain and the Role of Analgesic Drugs in Pain Management in Patients with Trauma in Emergency Department

Abstract

Background: Pain could potentially affect all aspects of patient admission course and outcome in emergency department (ED) when left undertreated. The alleviation of acute pain remains simply affordable but is usually, and sometimes purposefully, left untreated in patients with trauma. This study challenged the conventional emergency department policies in reducing the intensity of acute pain considering the pharmacological treatments.
Methods: In this case-control study, the prevalence and intensity of pain in 200 patients were evaluated on admission (T1) and 24 hours later (T2) based on the valid, standardized 10-point numeric rating scale (NRS 0-10) for pain intensity. A group of patients received analgesic drugs and others did not. Changes in pain patterns regarding different aspects of trauma injuries in these two groups were compared.
Results: The pain prevalence was high both on admission and 24 hours later. 51.5% of the study population received analgesics and 77.6% of them reported a decrease in the intensity of their pain. Only half of the patients, who did not receive any medication, reported a decrease in their pain intensity after 24 hours. The most beneficial policy to manage the acute pain was a combination therapy of the injury treatment and a supplementary pharmacological intervention.
Conclusions: Pharmacological management of pain in patients with trauma is shown to be significantly beneficial for patients as it eases getting along with the pain, and still seems not to affect the diagnostic aspects of the trauma. Pain management protocols or algorithms could potentially minimize the barriers in current pain management of patients with trauma.

1. Longo D, Fauci A, Kasper D, Hauser S, Jameson J,Loscalzo J. Harrison's principles of internal medicine.18th ed. New York, NY: McGraw Hill Professional; 2011.
2. Berben SA, Meijs TH, van Dongen RT, van Vugt AB,Vloet LC, Mintjes-de Groot JJ, et al. Pain prevalence and pain relief in trauma patients in the Accident & Emergency department. Injury. 2008; 39(5): 578-85.
3. Carr DB, Goudas LC. Acute pain. Lancet. 1999;353(9169): 2051-8.
4. Merskey H, Bogduk N. Classification of chronic pain descriptions of chronic pain syndromes and definitions of pain terms. 2nd ed. Washington, D.C: IASP Press; 2002.
5. Stalnikowicz R, Mahamid R, Kaspi S, Brezis M.Undertreatment of acute pain in the emergency department: a challenge. Int J Qual Health Care. 2005;17(2): 173-6.
6. Blank FS, Mader TJ, Wolfe J, Keyes M, Kirschner R,Provost D. Adequacy of pain assessment and pain relief and correlation of patient satisfaction in 68 ED fast-trackpatients. J Emerg Nurs. 2001; 27(4): 327-34.
7. Brown JC, Klein EJ, Lewis CW, Johnston BD,Cummings P. Emergency department analgesia for fracture pain. Ann Emerg Med. 2003; 42(2): 197-205.
8. Lewis LM, Lasater LC, Brooks CB. Are emergencyphysicians too stingy with analgesics? South Med J.1994; 87(1): 7-9.
9. Selbst SM, Clark M. Analgesic use in the emergencydepartment. Ann Emerg Med. 1990; 19(9): 1010-3.
10. Tanabe P, Thomas R, Paice J, Spiller M, Marcantonio R.The effect of standard care, ibuprofen, and music on painrelief and patient satisfaction in adults with musculoskeletaltrauma. J Emerg Nurs. 2001; 27(2): 124-31.
11. Wilson JE, Pendleton JM. Oligoanalgesia in theemergency department. Am J Emerg Med. 1989; 7(6):620-3.
12. Bijur PE, Latimer CT, Gallagher EJ. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Acad Emerg Med.2003; 10(4): 390-2.
13. Berthier F, Potel G, Leconte P, Touze MD, Baron D.Comparative study of methods of measuring acute pain intensity in an ED. Am J Emerg Med. 1998; 16(2): 132-6.
14. Guru V, Dubinsky I. The patient vs. caregiver perception of acute pain in the emergency department. J Emerg Med.2000; 18(1): 7-12.
15. Salmon P, Manyande A. Good patients cope with theirpain: postoperative analgesia and nurses' perceptions of their patients' pain. Pain. 1996; 68(1): 63-8.
16. Bijur PE, Berard A, Esses D, Nestor J, Schechter C,Gallagher EJ. Lack of influence of patient self-report of pain intensity on administration of opioids for suspected long-bone fractures. J Pain. 2006; 7(6): 438-44.
17. Motov SM, Khan A. Problems and barriers of pain management in the emergency department: Are we ever going to get better? J Pain Res. 2009; 2: 5-11.
18. Sandhu S, Driscoll P, Nancarrow, J, McHugh D.Analgesia in the accident and emergency department: do SHOs have the knowledge to provide optimal analgesia?J Accid Emerg Med. 1998; 15(3): 147-50.
19. Thomas SH, Silen W, Cheema F, Reisner A, Aman S,Goldstein JN, et al. Effects of morphine analgesia on diagnostic accuracy in Emergency Department patients with abdominal pain: a prospective, randomized trial. J Am Coll Surg. 2003; 196(1): 18-31.
20. Fowler M, Slater TM, Garza TH, Maani CV, DeSocioPA, Hansen JJ, et al. Relationships between early acutepain scores, autonomic nervous system function, and injury severity in wounded soldiers. J Trauma. 2011; 71(1Suppl): S87-S90.
Files
IssueVol 2 No 3-4 (2015) QRcode
SectionOriginal Article(s)
Keywords
Analgesic drugs Pain management Trauma Patients Emergency department
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Paydar S, Alizadeh M, Taheri R, Mousavi SM, Niakan H, Hoseini N, Bolandparvaz S, Shayan L, Ghahramani Z, Abbasi HR. The Prevalence of Pain and the Role of Analgesic Drugs in Pain Management in Patients with Trauma in Emergency Department. AJS. 2016;2(3-4):45-51.