SAN FRANCISCO – Many patients who come to emergency departments complaining of pain remain in pain after being sent home, even if they're discharged with pain medications, according to two prospective studies.
Either pain management plans are inadequate, or patients aren't using the medications properly–or both–the investigators suggested.
In one study, 326 adults rated their pain levels when leaving the emergency department and were contacted by phone 1 week after discharge. Average pain intensity ratings on an 11-point scale were 5.1 at the time of discharge and 4.5 at the 1-week follow-up for the 67% of patients who used prescribed pain medication after discharge.
Patients who did not use prescribed pain medication after discharge rated their pain intensity as an average of 4.1 at the time of discharge and 3.3 a week later, reported Matthew J. Larsen of the University of Utah, Salt Lake City.
Both groups reported experiencing some pain since discharge that was worse than the pain level at discharge. At the 1-week follow-up, patients rated their worst pain since discharge at 6.6 in the prescription pain medication group and 5.6 in the group that did not use prescription pain medication, he said at the annual meeting of the American College of Emergency Physicians.
“Patients continue to have high levels of average and worst pain 1 week after discharge from the emergency department. The use of prescription pain medication did not provide pain relief,” said Mr. Larsen, a medical student who worked on the study with David E. Fosnocht, M.D., and Eric R. Swanson, M.D., both of the university.
Preliminary results from a separate, ongoing study provided some clues to improving pain management, Knox H. Todd, M.D., said at a meeting of the American Society of Law, Medicine, and Ethics.
The study included 304 patients (mostly adults) seen in 13 U.S. and Canadian emergency departments for moderate to severe pain. The investigators reviewed patient charts and conducted phone interviews with patients a median of 6 days after discharge.
Only 36% of patients were pain free at the follow-up, and more than 30% were still in severe pain. Of the 196 patients who still suffered pain, 70% said that it interfered with their general activities, said Dr. Todd, who led the study while at Emory University, Atlanta, and who is currently at Beth Israel Medical Center, New York.
During their ED visits, which lasted a mean of 192 minutes, 110 minutes elapsed before patients received their first analgesic. “That's the same data we found 6-7 years ago when we studied emergency departments in Atlanta and Chicago. This is something structural that we can deal with,” Dr. Todd said.
Overall, 79% of patients received an initial pain assessment in the emergency department, but follow-up was poor, with only 17% receiving more than one pain assessment in the ED.
Communication problems were common and contributed to poor pain management. In the follow-up phone interviews, 72% of patients said they felt they had needed pain medication while in the ER, and 63% received analgesics; but only 26% said they had asked for pain relief. “Patients don't tend to ask,” Dr. Todd said. “This is an area ripe for education–teaching people how to talk to doctors about pain.”
Patients with chronic pain composed 44% of the cohort, with a median 2-year duration of pain. They used the emergency department much more often (a mean of four visits in the past year), compared with patients without chronic pain (one visit in the past year).
Approximately 60%-70% of people who come to emergency departments do so because of pain, he said, making pain the top reason for ED visits.