Introduction: Hispanic ethnicity has been reported as an independent risk factor for oligoanalgesia in the emergency department (ED).Objectives: The objectives are to compare pain management practices in White and Hispanic patients in the ED to determine whether treatment differences exist.Methods: Prospective analysis of a convenience sample of patients presenting to an urban, academic, tertiary-care ED over the 10-year period from 2000 to 2010. We compared patients with pain-related complaints of any nature, who self-identified their race as White or Hispanic, and evaluated initial morphine administration/dosing, arrival/disposition pain scores, and overall ED satisfaction scores (0-10 scale).Results: Fifteen thousand sixty patients were enrolled. Eighty-one point 2 percent (n, 12 232) of the patients were White and 11.2% (n, 1680), Hispanic. White and Hispanic patients reported similar pain at presentation (6.7 vs 7.3, P<.001) and discharge/admission (4.6 vs 4.8, P=.14). Hispanic patients were not less likely to receive an analgesic during the ED visit (odds ratio, 1.06; confidence interval, 0.96-1.17; P=.62), nor less likely to receive an opioid analgesic (odds ratio, 0.97; confidence interval, 0.88-1.08; P=.70). Hispanic patients, on average, received similar initial doses of morphine (4.1 vs 4.3 mg, P=.29) and had similar wait times from arrival to initial dose of morphine (82 vs 86 minutes). Overall ED satisfaction scores were the same (8.7 vs 8.7, P=.65).Conclusion: White and Hispanic patients were similar in rates of initial morphine administration for pain-related complaints. These findings contrast with previous studies reporting lower rates of initial analgesia administration among Hispanic patients in the ED. (C) 2014 Elsevier Inc. All rights reserved.

BACKGROUND:Abdominal pain is a top chief complaint of patients presenting to Emergency Departments (ED). Historically, uncertainty surrounded correct management. Evidence has shown adequate analgesia does not obscure the diagnosis, making it the standard of care.OBJECTIVE:We sought to evaluate trends in treatment of abdominal pain in an academic ED during a 10-year period.METHODS:We prospectively evaluated a convenience sample of patients in an urban academic tertiary care hospital ED from September 2000 through April 2010. Adult patients presenting with a chief complaint of abdominal pain were included in this study. Analgesic administration rates and times, pain scores, and patient satisfaction at discharge were analyzed to evaluate trends by year.RESULTS:There were 2,646 patients presenting with abdominal pain who were enrolled during the study period. Rates of analgesic administration generally increased each year from 39.9% in 2000 to 65.5% in 2010 (p value for trend <0.001). Similarly, time to analgesic administration generally decreased by year, from 116 min in 2000 to 81 min in 2009 (p < 0.001). There was no improvement in mean pain scores at discharge by year (p = 0.27) and 48% of patients during the 10-year period still reported moderate to severe pain at discharge. Patient satisfaction with pain treatment increased from a score of 7.1 to 9.0 during the study period (p < 0.005), following the trend of increase in analgesic administration.CONCLUSIONS:In patients presenting to the ED with abdominal pain, analgesia administration increased and time to medication decreased during the 10-year period. Despite overall improvements in satisfaction, significant numbers of patients presenting with abdominal pain still reported moderate to severe pain at discharge.

STUDY OBJECTIVE:The aim of this study is to compare the pain management practices in geriatric patients in the emergency department (ED) with that in other adult ED patients to determine whether these patients face increased risk of oligoanalgesia. METHODS:This study was a prospective analysis of a convenience sample of patients presenting to an urban academic tertiary care hospital ED from 2000 through 2010. We compared patients aged 65 years and older (geriatric) with adults younger than 65 years and evaluated analgesic administration rates, opioid administration and dosing, and pain and satisfaction scores (0 to 10 scale). RESULTS:A total of 15,387 patients presented to the ED during the 10-year study period and agreed to participate in the study; 1,169 patients were geriatric (7.6%). Geriatric patients had a mean age of 75.0 years (SD 7.2 years), whereas mean age of the 14,218 nongeriatric patients was 35.5 years (SD 12.2 years). Geriatric patients reported less pain at presentation (6.2 versus 6.9). After adjusting for presentation pain scores, geriatric patients were not less likely to receive an analgesic during the ED visit (odds ratio 0.90; 95% confidence interval 0.78 to 1.05) or less likely to receive an opioid (odds ratio 1.01; 95% confidence interval 0.87 to 1.18). Geriatric patients, on average, received lower doses of morphine (3.3 versus 4.2 mg) and had longer waiting times for their initial dose of an analgesic medication (65 versus 75 minutes). CONCLUSION:Despite longer wait times for analgesia, geriatric and nongeriatric patients were similar in rates of analgesia and opioid administration for pain-related complaints. These findings contrast with previous studies reporting lower rates of analgesia administration among geriatric patients.

We demonstrate and evaluate a method for modeling acute pain resolution in individual patients over 6 days following an emergency department visit for an acutely painful condition. Five hundred and thirteen patients presenting with acutely painful conditions provided 11-point numerical ratings of pain intensity at discharge from an emergency department and daily thereafter for a total of 6 days. Latent growth curve modeling with a linear fit yielded measures of initial pain intensity (intercept) and rate of pain resolution (slope) for each individual patient. The linear fits provided good approximations of individual pain trajectories. The average patient had intercept of 6.57 with a slope of -.61. On Day 4, 54.6% of patients reported a pain level equal to or greater than 4. Classification of individual patients by slope revealed that 79% of the sample had the expected negative slope for acute pain resolution while 21% had flat or positive slopes, indicating lack of pain resolution or worsening of pain over time following discharge. The standard errors of measurement for the acute pain trajectories were markedly smaller than those for conventional pain ratings, indicating that the trajectory approach to pain measurement improves measurement precision.Perspective: The acute pain trajectory provides more information than conventional pain measurement and increases measurement precision. It provides a means of determining the efficacy of acute pain management in the emergency department. The rate of pain resolution is a potentially valuable outcome measure for controlled clinical trials. (C) 2012 by the American Pain Society

BackgroundThe lack of adequate pain treatment for patients in the emergency department (ED) has been well documented. The reasons often cited for the lack of effective pain management have included inadequate research and a subsequent limitation of options for practicing emergency physicians. American College of Emergency Physicians have advocated additional research in the area of pain management for acute injury and illness.Study ObjectiveThe aim of this study was to describe pain management practices of an academic center over 10 years and to provide epidemiologic and population-based pain data to improve the quality of pain management for patients within the ED.MethodsWe prospectively enrolled patients presenting to an urban academic tertiary care hospital ED from 2000 through 2010. All adult patients who reported pain were eligible for inclusion in the study. We recorded patient demographics, pain and satisfaction scores (0-10 scale), analgesic type and administration times.Results15,485 patients were enrolled during the study period with a mean age of 38 years and 45% of whom were male. Isolated extremity pain (29.5%), abdominal pain (17.5%), and back pain (12.8%) were the most common chief complaints. Average pain scores at presentation, 30 minutes, and discharge were 6.8, 5.4, and 4.69, respectively. Most patients described their pain as moderate to severe at presentation (81.7%) and more than half of these patients (54.5%) continued to describe moderate to severe pain at discharge. Only 47% of patients received an analgesic during their ED stay, and the average time to receipt of the first pain medication was 82.5 minutes. Patients who received analgesics reported both higher pain scores at presentation (7.7 vs. 6.1, p<0.001) and higher satisfaction scores at discharge (8.4 vs. 7.7, p<0.001), but reported similar pain scores at discharge to those who did not receive analgesics (4.7 vs. 4.7, p=0.35). Morphine was the most common analgesic administered (37.1%) and 40% of patients reported taking an analgesic medication prior to coming to the ED. Overall patient satisfaction with their ED pain management at discharge was high (8.1).ConclusionIn our 10-year experience, less than half of ED patients who reported pain received medications to treat their pain, with more than half of patients continuing to describe moderate/severe pain at the time of discharge. This large study highlights the issue of oligoanalgesia among ED patients presenting with pain-related complaints. BackgroundThe lack of adequate pain treatment for patients in the emergency department (ED) has been well documented. The reasons often cited for the lack of effective pain management have included inadequate research and a subsequent limitation of options for practicing emergency physicians. American College of Emergency Physicians have advocated additional research in the area of pain management for acute injury and illness. The lack of adequate pain treatment for patients in the emergency department (ED) has been well documented. The reasons often cited for the lack of effective pain management have included inadequate research and a subsequent limitation of options for practicing emergency physicians. American College of Emergency Physicians have advocated additional research in the area of pain management for acute injury and illness. Study ObjectiveThe aim of this study was to describe pain management practices of an academic center over 10 years and to provide epidemiologic and population-based pain data to improve the quality of pain management for patients within the ED. The aim of this study was to describe pain management practices of an academic center over 10 years and to provide epidemiologic and population-based pain data to improve the quality of pain management for patients within the ED. MethodsWe prospectively enrolled patients presenting to an urban academic tertiary care hospital ED from 2000 through 2010. All adult patients who reported pain were eligible for inclusion in the study. We recorded patient demographics, pain and satisfaction scores (0-10 scale), analgesic type and administration times. We prospectively enrolled patients presenting to an urban academic tertiary care hospital ED from 2000 through 2010. All adult patients who reported pain were eligible for inclusion in the study. We recorded patient demographics, pain and satisfaction scores (0-10 scale), analgesic type and administration times. Results15,485 patients were enrolled during the study period with a mean age of 38 years and 45% of whom were male. Isolated extremity pain (29.5%), abdominal pain (17.5%), and back pain (12.8%) were the most common chief complaints. Average pain scores at presentation, 30 minutes, and discharge were 6.8, 5.4, and 4.69, respectively. Most patients described their pain as moderate to severe at presentation (81.7%) and more than half of these patients (54.5%) continued to describe moderate to severe pain at discharge. Only 47% of patients received an analgesic during their ED stay, and the average time to receipt of the first pain medication was 82.5 minutes. Patients who received analgesics reported both higher pain scores at presentation (7.7 vs. 6.1, p<0.001) and higher satisfaction scores at discharge (8.4 vs. 7.7, p<0.001), but reported similar pain scores at discharge to those who did not receive analgesics (4.7 vs. 4.7, p=0.35). Morphine was the most common analgesic administered (37.1%) and 40% of patients reported taking an analgesic medication prior to coming to the ED. Overall patient satisfaction with their ED pain management at discharge was high (8.1). 15,485 patients were enrolled during the study period with a mean age of 38 years and 45% of whom were male. Isolated extremity pain (29.5%), abdominal pain (17.5%), and back pain (12.8%) were the most common chief complaints. Average pain scores at presentation, 30 minutes, and discharge were 6.8, 5.4, and 4.69, respectively. Most patients described their pain as moderate to severe at presentation (81.7%) and more than half of these patients (54.5%) continued to describe moderate to severe pain at discharge. Only 47% of patients received an analgesic during their ED stay, and the average time to receipt of the first pain medication was 82.5 minutes. Patients who received analgesics reported both higher pain scores at presentation (7.7 vs. 6.1, p<0.001) and higher satisfaction scores at discharge (8.4 vs. 7.7, p<0.001), but reported similar pain scores at discharge to those who did not receive analgesics (4.7 vs. 4.7, p=0.35). Morphine was the most common analgesic administered (37.1%) and 40% of patients reported taking an analgesic medication prior to coming to the ED. Overall patient satisfaction with their ED pain management at discharge was high (8.1). ConclusionIn our 10-year experience, less than half of ED patients who reported pain received medications to treat their pain, with more than half of patients continuing to describe moderate/severe pain at the time of discharge. This large study highlights the issue of oligoanalgesia among ED patients presenting with pain-related complaints. In our 10-year experience, less than half of ED patients who reported pain received medications to treat their pain, with more than half of patients continuing to describe moderate/severe pain at the time of discharge. This large study highlights the issue of oligoanalgesia among ED patients presenting with pain-related complaints.

Background: Treatment of pain in the emergency department (ED) is a significant area of focus, as previous studies have noted generally inadequate treatment of pain in ED patients. Previous studies have not evaluated the impact of computerized physician order entry (CPOE) on the treatment of pain in the ED. We sought to evaluate treatment of pain before and after implementation of CPOE in an academic ED.Methods: We prospectively enrolled a convenience sample of patients presenting to the ED with a pain-related complaint in 4-month periods before and after CPOE implementation. We compared numbers who received pain medications, time from registration to administration of pain medication, and repeat dosing of pain medication.Results: Six hundred forty-six ED patients participated in the pre-CPOE period, whereas 592 patients participated post-CPOE. Similar numbers of patients received pain medications in the pre-CPOE and post-CPOE periods (55% vs 59%; P = .139), whereas those in the post-CPOE period were more likely to receive a repeat dose of pain medications ( 10.5% vs 17.6%; P < .001).Conclusion: The use of CPOE in the ED may offer modest benefits in the treatment of patients with pain-related complaints. (c) 2012 Published by Elsevier Inc.

Objectives: This study was designed to evaluate patient knowledge of the acetaminophen (paracetamol) content of commonly used pain medications and the maximum daily recommended dose of acetaminophen. Methods: A prospective, convenience sample of emergency department patients were enrolled. Data were recorded using a standardised questionnaire over 4 months. Results: 1009 patients were enrolled. 492 patients (49%) did not know if Tylenol® contained acetaminophen (paracetamol). The majority (66–90%) of patients did not know if Lortab®, Vicodin®, Percocet®, non-aspirin pain reliever, ibuprofen, Motrin™, or Advil™ contained acetaminophen. 568 patients (56%) reported not knowing the maximum daily dose of acetaminophen and only 71 patients (7%) reported the correct daily dose. Conclusions: Patient knowledge of the acetaminophen content of commonly used analgesic medications and its maximum recommended daily dose is limited. This may contribute to unintentional repeated supratherapeutic ingestion (RSTI) of acetaminophen, or overdose.

The purpose of this study was to evaluate changes in pain intensity using a verbal descriptive scale from emergency department (ED) arrival to discharge.

The concepts of patient expectation and desired outcomes for patients with acute pain in the emergency department (ED) are surprisingly simple. Most patients present to the ED with pain. Patients with pain expect pain relief. The obvious desired outcome is relief of pain. Our ability to move from this simplistic ideal to scientific, evidence-based solutions that facilitate patient expectations, at the same time defining reasonable outcomes for pain relief, is much more complex. This complexity accounts for a great deal of the continued problem of inadequate pain management in the ED.

The purpose of this study was to evaluate differences in pain intensity for grouped chief complaints at the time of initial evaluation and at 5 days after discharge from the emergency department (ED).

The purpose of this study was to validate the ordinal quality of 12 sets of acute pain word descriptors as potential measurement tools for use in the emergency department.

Purposes: This study was designed to evaluate the ability of a triage pain protocol to improve frequency and time to delivery of analgesia for musculoskeletal injuries in the emergency department (ED).Basic Procedures: Frequency and time to analgesic administration were measured before and after use of a triage pain protocol. The protocol allowed analgesic medications to be given at the time of triage.Main Findings: Time to medication administration was 76 minutes (95% confidence interval [CI], 68-84 minutes) before and 40 minutes (95% CI, 32-47 minutes) after the protocol. Five hundred fifty-nine (70%) of 800 patients received analgesics using the protocol compared with 212 of 471 (45%) patients prior.Principal Conclusions: Use of a triage pain protocol increased the number of patients with musculoskeletal injury who received pain medication in the ED. Use of the protocol also resulted in a decrease in the time to analgesic medication administration. (C) 2007 Elsevier Inc. All rights reserved.

UNLABELLED:Pain is the most common reason for emergency department (ED) use, and oligoanalgesia in this setting is known to be common. The Joint Commission on Accreditation of Healthcare Organizations has revised standards for pain management; however, the impact of these regulatory changes on ED pain management practice is unknown. This prospective, multicenter study assessed the current state of ED pain management practice. After informed consent, patients aged 8 years and older with presenting pain intensity scores of 4 or greater on an 11-point numerical rating scale completed structured interviews, and their medical records were abstracted. Eight hundred forty-two patients at 20 US and Canadian hospitals participated. On arrival, pain intensity was severe (median, 8/10). Pain assessments were noted in 83% of cases; however, reassessments were uncommon. Only 60% of patients received analgesics that were administered after lengthy delays (median, 90 minutes; range, 0 to 962 minutes), and 74% of patients were discharged in moderate to severe pain. Of patients not receiving analgesics, 42% desired them; however, only 31% of these patients voiced such requests. We conclude that ED pain intensity is high, analgesics are underutilized, and delays to treatment are common. Despite efforts to improve pain management practice, oligoanalgesia remains a problem for emergency medicine. PERSPECTIVE:Despite the frequency of pain in the emergency department, few studies have examined this phenomenon. This study documents high pain intensity and suboptimal pain management practices in a large multicenter ED network in the United States and Canada. These findings suggest that there is much room for improvement in this area.

To assess the ease of use, utility and accuracy of the 11 point 0-10 numeric rating scale (NRS) in emergency department (ED) patients.