Patient preferences regarding pain medication in the ED

doi:10.1053/ajem.2000.7313

The American Journal of Emergency Medicine

Volume 18, Issue 4, July 2000, Pages 376-380

https://doi.org/10.1053/ajem.2000.7313 Get rights and content

Abstract

Previous studies have reported inadequate pain control in the emergency department (ED). The primary purpose of this study was to determine the proportion of ED patients with acute fractures who actually wanted pain medication given in the ED. A convenience sample of 107 adults with acute long-bone fractures seen in a community hospital ED were surveyed on the pain level they had on ED presentation, the pain level desired at ED discharge, and their preferences for administration of analgesia in the ED. Eighty-eight percent of the patients wanted pain medication given in the ED and 77% actually received it. Sixty-nine percent were comfortable with a nurse administering pain medication before physician evaluation. Seventy percent wanted pain control without being sedated and 25% wanted complete pain relief even if sedation was necessary to achieve it. Sixty percent were either slightly concerned or not concerned about potential medication side effects. (Am J Emerg Med 2000;18:376-380. Copyright © 2000 by W.B. Saunders Company)

Section snippets

Methods

A convenience sample was taken from all patients with long-bone fractures presenting to the ED of St. Joseph Mercy Hospital, a 550-bed community teaching hospital with a Level II Trauma Center located in Ann Arbor, Michigan. The ED has an annual census of 64,000 and is staffed by emergency medicine faculty as well as residents in emergency medicine, internal medicine and transitional (rotating internship) training programs. The study took place over a 15-month period between July 1997 and

Results

One hundred-nine patients were approached for enrollment on the study. One patient refused participation and one was excluded because of incomplete data, leaving 107 patients in the final study sample. The mean age was 57 years (range 18 to 94 years) and 41% were 65 years of age or older. Sixty-five percent of the subjects were women, 85% were Caucasian and 14% were African American. In terms of fracture location, 42% of the subjects had fractures of the radius or ulna (including wrist), 30%

Discussion

We found that 88% (94/107) of our patients with acute long-bone fractures wanted pain medication given in the ED. This group had an initial pain level of 69 mm on a 100-mm visual analog scale. In contrast, 12% of our study patients, with an initial pain level of 29 mm, declined pain treatment in the ED. The difference between these two groups in initial pain levels was statistically significant.

These results suggest that most, but not all, patients with long-bone fractures want pain medication

Conclusion

Alleviating pain and suffering is a traditional goal of medical care. Past studies have shown that a large number of ED patients with extremity fractures are not treated for pain. We found that 88% of the patients who presented with acute long-bone fractures wanted pain medication given in the ED, and 77% actually were treated for their pain. Almost 7 out of 10 were willing to accept pain medication given by the ED nurse before the physician evaluation. In addition, patients preferred the

Acknowledgements

The authors wish to acknowledge the statistical and editorial assistance of Brenda Gillespie, PhD, of the University of Michigan Center for Statistical Consultation and Research.

References (8)

JE Wilson et al.
Oligoanalgesia in the emergency department
Am J Emerg Med
(1989)
SM Selbst et al.
Analgesia use in the emergency department
Ann Emerg Med
(1990)
R Melzack et al.
Acute pain in an emergency clinic: Latency of onset and descriptor patterns related to different injuries
Pain
(1982)
KH Todd et al.
Ethnicity as a risk factor for inadequate emergency department analgesia
JAMA
(1993)

There are more references available in the full text version of this article.

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Legislation, practice recommendations, and the likely link between therapeutic opioid exposure and iatrogenic opioid use disorder (OUD) have led to reduced opioid prescribing. The effects of this change on unrelieved pain and the overdose crisis are not well-characterized.
We explored emergency department (ED) patients’ beliefs and experiences involving pain and emergency care to inform the development of future psychosocial interventions that balance the need for acute pain management with risks from opioid exposure.
Qualitative, semi-structured interviews were conducted after discharge from an urban, academic Level 1 trauma center ED from September 2020 to May 2021 with 18 adult patients presenting with acute pain. After transcription of audio recording, common themes were identified using framework analysis. Thematic hierarchy was validated with Pearson correlation coefficients for cluster analysis of word similarity.
Of the 18 participants, most were Black (n = 11, 61%) and male (n = 12, 66.7%). Analysis identified one overarching theme: locus of control with an emergency pain encounter. Four themes were identified surrounding internal and external influences on pain management: (1) accessing healthcare for acute pain; (2) managing the pain after discharge; (3) seeking opioids: self-medicating and misuse; and (4) opioid crisis makes people in pain suffer.
Patients discharged from the ED reported unrelieved pain, factors that influence their pain management, and an ability to seek opioids from non-medical sources. There is a significant disconnect between patients and providers in terms of priorities in pain management and the importance of individualized care.
Emergency Nurse Perceptions of Pain and Opioids in the Emergency Department
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Since ED opioid prescriptions are typically prescribed for short time frames (Jeffery et al., 2018), they alone may not be enough to cause OUD. Complicating matters further, patients frequently report inadequate pain control for acute injuries in the ED (Beel et al., 2000; Tanabe & Buschmann, 1999; Todd et al., 2007). Unrelieved pain is also an epidemic with important health consequences (Blomqvist, 2003; Schwaller & Fitzgerald, 2014).
The opioid crisis is a national health emergency with immense morbidity, mortality, and socioeconomic cost. Emergency department (ED) pain management is tightly linked to the issue of opioid use disorder (OUD), because opioid exposure is necessary for development of OUD. Emergency nurses are on the frontlines of this complex problem, yet little, if any, attention has been paid to the role they play in the prevention and management of either pain or OUD in this unique and important setting. A framework that conceptualizes and optimizes emergency nurses as change agents in the opioid epidemic is urgently needed. While ED pain management and OUD prevention is dependent on the entire care team, this innovative study qualitatively characterizes emergency nurse perceptions of pain management, OUD prevention, and their potential role in each. Content analysis produced 14 categories that were clustered into two themes, “nurses influence ED pain management” and “adjustments in ED pain management”, and an overarching message that “pain management depends on the care team.” By generating a more comprehensive and nuanced understanding of the role played by emergency nurses, our findings provide essential insights into potential interventions and frameworks.
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Gueant and colleagues51 identified reasons for inadequate analgesia and measures to improve quality of ED pain management. Patient surveys report 23 minutes as a reasonable time to wait for ED pain medication, yet studies demonstrate an average wait time of 2.3 hours.52 Guidelines (see previous discussion) list goals that ED providers should attain in the care of elders with pain.
Patient Perspectives of Acute Pain Management in the Era of the Opioid Epidemic
2015, Annals of Emergency Medicine
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The prevalence of pain as the presenting complaint in emergency departments (EDs) ranges between 38% and 78%.3-5 Up to 70% of patients with acute pain fail to receive any analgesics in the ED.6-9 Previously noted barriers to adequate pain management included provider failure to acknowledge pain, failure to document pain, inadequate training on analgesia, and sociodemographic biases.10
To inform the development of interventions that could improve patient engagement around the risks and benefits of alternative approaches to pain management in the emergency department (ED), we seek to capture the perspectives and experiences of patients treated for pain in this setting.
Three trained interviewers conducted semistructured open-ended telephone interviews with patients discharged from a single urban academic ED after presenting with acute pain related to fracture, renal colic, or musculoskeletal back injury. We recruited subjects until achieving thematic saturation according to periodic review of the interview transcripts. Interviews were audio recorded, professionally transcribed, and uploaded into QSR NVivo (version 10.0) for coding and analysis using modified grounded theory. An interdisciplinary team double coded the data and convened to review emerging themes, ensure interrater reliability, and establish consensus on discrepancies.
We had 23 completed subject interviews, the majority of which were women. Interrater reliability for coding exceeded 90%. The major themes elicited centered on domains of patient awareness of the potential for opioid dependence and patient-provider communication relating to pain management. From the patient perspective, emergency physicians typically do not present alternative pain management options or discuss the risks of opioid dependence. Patients with negative experiences related to pain management describe deficiencies in patient-provider communication leading to misunderstanding of clinical diagnoses, fragmentation of care among their health care providers, and a desire to be involved in the decisionmaking process around their pain management. Patients with positive experiences commented on regular communication with their care team, rapid pain management, and the empathetic nature of their care providers. Patients communicate fears about the risks of opioid addiction, beliefs that following a prescribed opioid regimen is protective of developing opioid dependence, and an understanding of the broader tensions that providers face relating to the prescription of opioid therapy.
Patients identified a deficit of communication around opioid risk and pain management options in the ED.
Acute Pain Management in Older Adults in the Emergency Department
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Level of pain and waiting time in the emergency department
2010, Pain Management Nursing
Pain is the leading reason individuals seek emergency care. Studies have concluded that acute pain conditions are underevaluated and undertreated in the emergency department (ED). There is a paucity of information about how the severity of pain influences the time spent in the ED before being seen by a physician. Therefore, this study focuses on what role pain plays regarding time to treatment in the ED, i.e., to examine the effects of patients' perceived level of pain on wait time in the ED. The CDC's National Hospital Ambulatory Medical Survey 2003 data were used in this study. The sample consisted of 12,860 caucasians and African Americans with a mean age of 44.52 years. Analysis of covariance was used to explore differences in length of waiting time in ED based on race, triage nurses rating of the immediacy of the need to be seen by a physician, and the level of pain the patient reported. The findings showed that patients' reports of pain had very little effect on the length of waiting time. Given the sample size, we feel there is adequate power to detect the effect of pain in determining the length of waiting time to see a physician if it were present. In addition, African Americans had a statistically significant longer wait (15.29minutes) than Whites. The effect of race might be interpreted as another example of health disparities or could be a hospital-level effect which was not examined within this model.

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^☆: Returned July 13, 1999.

^☆☆: Address reprint requests to Todd L. Beel, MD, Department of Emergency Medicine, St. Joseph Mercy Hospital, PO Box 995, Ann Arbor, MI, 48106-0995. Email: [email protected]

^★: Am J Emerg Med 2000;18:376-380.

^★★: 0735-6757/00/1804-0004$10.00/0

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Original ContributionsPatient preferences regarding pain medication in the ED☆,☆☆,★,★★

Abstract

Section snippets

Methods

Results

Discussion

Conclusion

Acknowledgements

Am J Emerg Med

Ann Emerg Med

Pain

Ethnicity as a risk factor for inadequate emergency department analgesia

JAMA

Original Contributions
Patient preferences regarding pain medication in the ED☆,☆☆,★,★★