Emerg Med J doi:10.1136/emermed-2012-201111
  • Original article

Patients' and emergency clinicians' perceptions of improving pre-hospital pain management: a qualitative study

  1. A Niroshan Siriwardena1,2
  1. 1East Midlands Ambulance Service NHS Trust, Lincoln, UK
  2. 2Lincoln School of Health and Social Care, University of Lincoln, Lincoln, UK
  1. Correspondence to Professor A Niroshan Siriwardena, Faculty of Health, Life & Social Sciences, University of Lincoln, Brayford Pool Lincoln LN6 7TS, UK; nsiriwardena{at}
  1. Contributors ANS conceived the original idea for the study. PAS and MI undertook the interviews and focus groups. All authors contributed to the design and conception of the paper. ANS wrote the first draft of the paper. All authors contributed to the discussion and the final draft of the paper. ANS is guarantor for the study.

  • Accepted 23 March 2012
  • Published Online First 27 April 2012


Background The authors aimed to investigate patients' and practitioners' views and experiences of pre-hospital pain management to inform improvements in care and a patient-centred approach to treatment.

Methods This was a qualitative study involving a single emergency medical system. Data were gathered through focus groups and semi-structured interviews. Participants were purposively sampled from patients transported by ambulance to hospital with a painful condition during the past 6 months, ambulance service and emergency department (ED) clinicians. Interviews were audiotaped, transcribed and thematic analysis was conducted.

Results 55 participants were interviewed: 17 patients, 25 ambulance clinicians and 13 ED clinicians. Key themes included: (1) consider beliefs of patients and staff in pain management; (2) widen pain assessment strategies; (3) optimise non-drug treatment; (4) increase drug treatment options; and (5) enhance communication and coordination along the pre-hospital pain management pathway. Patients and staff expected pain to be relieved in the ambulance; however, refusal of or inadequate analgesia were common. Pain was commonly assessed using a verbal score, but practitioners' views of severity were sometimes discordant with this. Morphine and Entonox were commonly used to treat pain. Reassurance, positioning and immobilisation were used as alternatives to drugs. Pre-hospital pain management could be improved by addressing practitioner and patient barriers, increasing available drugs and developing multi-organisational pain management protocols supported by training for staff.

Conclusions Pain is often poorly managed and undertreated in the pre-hospital environment. The authors' findings may be used to inform guidance, education and policy to improve the pre-hospital pain management pathway.


  • Funding The study was funded by Trent Research and Development Support Unit and East Midlands Ambulance Service NHS Trust.

  • Competing interests None.

  • Ethics approval This study was approved by Nottingham Research Ethics Committee 2 (07/H0408/112) and the Ethics Committee of the University of Lincoln. Approval for Research Management and Governance was sought and obtained from NHS Lincolnshire, East Midlands Ambulance Services NHS Trust and United Lincolnshire Hospitals NHS Trust.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement The authors are happy to share data. The corresponding author is happy to receive direct requests.

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