Nurse-initiated oral opioid pain protocol improves the quality of musculoskeletal pain management in the emergency department

We examined the relative impact of baseline anxiety, depression and fear of movement on health related quality of life at 12-month follow-up after a multidisciplinary pain management programme. One hundred and eleven patients who had chronic musculoskeletal pain (mean age 45 years, 65% women) attended during 2003–2005 a multidisciplinary three-phase pain management programme with a total time frame of six to seven months, totalling 19 days. The Beck Anxiety Inventory was used to rate anxiety, the Beck Depression Inventory depression, the Tampa Scale of Kinesiophobia fear of movement. The generic 15D questionnaire was used to assess health related quality of life. Baseline data were collected at admission, follow-up data at 12 months. Mean health related quality of life increased significantly from baseline to 12-month follow-up. Anxiety at baseline predicted significant negative change in the health related quality of life, depression predicted significant positive change in the health related quality of life. Fear of movement did not predict any significant change in the health related quality of life. We concluded that patients with chronic musculoskeletal pain and mild to moderate depression benefit from a multidisciplinary pain management programme in contrast to anxious patients. The findings imply further research with bigger sample sizes, other than HRQoL outcome measures as well as with other groups of patients.

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Pain management in the emergency department: a clinical review

Clinical and Experimental Emergency Medicine ◽

10.15441/ceem.21.161 ◽

2021 ◽

Vol 8 (4) ◽

pp. 268-278

Author(s):

Sergey M. Motov ◽

Katherine Vlasica ◽

Igor Middlebrook ◽

Alexis LaPietra

Keyword(s):

Emergency Department ◽

Pain Management ◽

Clinical Review ◽

Musculoskeletal Pain ◽

Pharmacological Treatment ◽

Treatment Modalities ◽

Evidence Based ◽

Opioid Prescribing ◽

Analgesic Regimen ◽

Current Practices

Pain is one of the most common reasons for patients to visit the emergency department. The ever-growing research on emergency department analgesia has challenged the current practices with respect to the optimal analgesic regimen for acute musculoskeletal pain, safe and judicious opioid prescribing, appropriate utilization of non-opioid therapeutics, and non-pharmacological treatment modalities. This clinical review is set to provide evidence-based answers to these challenging questions.

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The effect of pain management in reducing limb and spine radiography in stable traumatic patients admitted to the emergency department

Trauma ◽

10.1177/1460408617752206 ◽

2018 ◽

Vol 21 (2) ◽

pp. 107-112 ◽

Cited By ~ 1

Author(s):

Mehdi Torabi ◽

Ali Mehri ◽

Moghaddameh Mirzaei

Keyword(s):

Emergency Department ◽

Patient Satisfaction ◽

Pain Management ◽

Musculoskeletal Pain ◽

Hospital Costs ◽

Primary Outcome Measure ◽

Lower Limbs ◽

Trauma Patients ◽

X Rays ◽

Management Protocol

Introduction Musculoskeletal pain caused by trauma is one of the common complaints of patients referred to the emergency department. Due to the lack of a proper pain control protocol, doctors and nurses do not pay attention to pain, and physicians may tend to request too many radiographs, many of which will be unnecessary. We aimed to study the effect of pain management by fentanyl in reducing the number of radiographs, reducing hospital costs and increasing satisfaction in the patients on patients with isolated trauma in limbs and spine causing musculoskeletal pain. Patients and methods A cohort of patients who were referred to the fast-track emergency department with isolated trauma of the upper and lower limbs or spine and triage levels 3, 4 and 5, were visited twice by an emergency medicine resident – before and after application of a pain management protocol using intravenous fentanyl as the principle analgesic. The primary outcome measure was the reduction in the number of radiographs requested; secondary outcomes included alterations in pain levels and patient satisfaction. Results A total of 158 patients were included in the study. The median age was 27.5 years, three quarters were male and 20.88% had a positive history of opium addiction. The number and costs of diagnostic radiography significantly decreased after the administration of fentanyl (P < 0.0001), as did pain levels measured on visual analogue scale with a consequent increase in patient satisfaction. There were only six complications resulting from fentanyl administration which were mild and transient. Follow-up after 24–72 h, revealed no missed fractures. Conclusions The administration of fentanyl as a strong analgesic as part of an emergency department pain management protocol for trauma patients can be performed with limited minor complications; it can reduce the number of unnecessary X-rays performed, exposure to ionizing radiation and hospital costs as well as improving patient satisfaction without missing fractures.

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The National Trend in Quality of Emergency Department Pain Management for Long Bone Fractures

Academic Emergency Medicine ◽

10.1197/j.aem.2006.08.015 ◽

2007 ◽

Vol 14 (2) ◽

pp. 163-169 ◽

Cited By ~ 12

Author(s):

Tamara S. Ritsema ◽

Gabor D. Kelen ◽

Peter J. Pronovost ◽

Julius Cuong Pham

Keyword(s):

Emergency Department ◽

Pain Management ◽

Bone Fractures ◽

Long Bone ◽

National Trend ◽

Long Bone Fractures

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The national trend in quality of emergency department pain management for long bone fractures

Acute Pain ◽

10.1016/j.acpain.2007.04.017 ◽

2007 ◽

Vol 9 (2) ◽

pp. 100-101

Author(s):

T.S. Ritsema ◽

G.D. Kelen ◽

P.J. Pronovost ◽

J.C. Pham

Keyword(s):

Emergency Department ◽

Pain Management ◽

Bone Fractures ◽

Long Bone ◽

National Trend ◽

Long Bone Fractures

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Quality of pain management in the emergency department: results of a multicentre prospective study

European Journal of Anaesthesiology ◽

10.1097/eja.0b013e3283418fb0 ◽

2011 ◽

Vol 28 (2) ◽

pp. 97-105 ◽

Cited By ~ 46

Author(s):

Sophie Guéant ◽

Ariski Taleb ◽

Jocelyne Borel-Kühner ◽

Maxime Cauterman ◽

Maurice Raphael ◽

...

Keyword(s):

Emergency Department ◽

Pain Management ◽

Prospective Study ◽

Multicentre Prospective Study

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No gender-related bias in acute musculoskeletal pain management in the emergency department

Emergency Medicine Journal ◽

10.1136/emermed-2013-202716 ◽

2013 ◽

Vol 32 (2) ◽

pp. 149-152 ◽

Cited By ~ 10

Author(s):

Ofir Uri ◽

Shlomo Elias ◽

Eyal Behrbalk ◽

Pinchas Halpern

Keyword(s):

Emergency Department ◽

Pain Management ◽

Musculoskeletal Pain

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Pain Management and Its Related Factors in the Emergency Department of Besat Hospital in Sanadaj, 2016

Internal Medicine And Medical Investigation Journal ◽

10.24200/imminv.v2i2.53 ◽

2017 ◽

Vol 2 (2) ◽

pp. 33

Author(s):

Behnam Movahedi ◽

Elham Khanlarzadeh ◽

Leila Azizkhani ◽

Aysan Noori

Keyword(s):

Emergency Department ◽

Pain Management ◽

Pain Intensity ◽

Injection Pain ◽

Related Factors ◽

Before And After ◽

Reduction Of Pain ◽

Health Related ◽

Control Pain

Abstract:Background: Pain is a distressing feeling as well as a discomfort which triggers as the result of a special stimulation of nerve endings.This study aimed to investigate the amount of sufficient pain management among patients referring to the emergency department in Besat Hospital in the city of Sanandaj in Iran.Material and Methods: in this descriptive-analytical study, 175 patients with severe pain intensity higher than 3 and definite causes of pain with physical origins admitted to the emergency department were included. Before and after analgesics injection, pain intensity was assessed by a 10-point scoring system.Results: No significant correlation showed between pain intensity in patients, administration of painkillers, and age (P>0.05).There was a statistically significant relationship between pain intensity, gender, and the type of analgesics received (P<0.05). The findings of this study also revealed that reduction of pain was not significantly correlated with age, gender, referral time, and administration of painkillers on patients (P> 0.05).Conclusion: Failure to control pain among patients can lead to physical, mental, psychological, and social health-related problems. Therefore, proper examination of pains can provide suitable interventions in order to control and manage pains among patients and consequently promote their quality of life.

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