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Analgesia in the emergency department: why is it not administered?
  1. Joyce Kant1,2,
  2. Mahesha Dombagolla1,2,
  3. Fiona Lai1,2,
  4. Andreas Hendarto1,2,
  5. David McDonald Taylor1,2
  1. 1 Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia
  2. 2 Faculty of Medicine and Radiology, University of Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Professor David McDonald Taylor, Emergency Department, Austin Hospital, Heidelberg, VIC 3084, Australia; david.taylor{at}


Objective Pain management in the ED is often suboptimal, with many patients not receiving analgesia. We aimed to determine why some patients refuse it, why others do not receive it, and whether these variables impact on patient satisfaction with their pain management.

Methods We undertook a prospective, observational study in a large, Australian, tertiary referral ED (February–May 2017). A convenience sample of consecutive adult patients with a triage pain score of ≥4 were examined. Data were collected from the medical record and the treating nurses. At follow-up at least 48 hours postdischarge, patients were asked if they received analgesia in the ED (if not, then why not) and how satisfied they were with their pain management (very dissatisfied/dissatisfied/slightly dissatisfied/slightly satisfied/satisfied/very satisfied). The primary outcome was why patients refuse analgesia.

Results Of the 651 enrolled patients, 171 (26.3%) did not receive analgesia; for 30 (17.5%), patients and their nurses agreed that analgesia was refused. Patients mainly refused analgesia because their pain was not bad enough, they had recent analgesia intake, and concerns about side effects and interactions. Patients who received analgesia were more likely to be ‘very satisfied’ with their pain management (difference in proportions 10.8%, 95% CI 2.1 to 19.4). The satisfaction of patients who refused analgesia and those who did not receive analgesia for other reasons did not differ.

Conclusion Patient refusal is the most common reason for patients not receiving analgesia. Analgesia receipt is associated with greater patient satisfaction. However, a patient’s knowledge of their analgesia receipt status may be incorrect. Disregard of the reasons for patients not receiving analgesia may underestimate the number offered analgesia.

  • emergency department
  • analgesia/pain control

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  • Contributors JK and DMcDT developed the protocol for the project that this research was drawn from. DMcDT obtained ethics committee approval. JK, FL, MD and AH collected all the data and assisted DMcDT in the analysis and interpretation. All authors contributed to drafting and critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study protocol and procedure were approved by the Austin Health Human Research Ethics Committee (HREC), Melbourne, Australia.

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

  • Data sharing statement There are no additional unpublished data from this study. However, the authors will make the study data available to other investigators for educational and research purposes. This will be done upon request to the corresponding author.