scholarly journals The simple query “Do you want more pain medication?” is not a reliable way to assess acute pain relief in patients in the emergency department

CJEM ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 21-27 ◽  
Author(s):  
Jean-Marc Chauny ◽  
Martin Marquis ◽  
Jean Paquet ◽  
Gilles Lavigne ◽  
Alexis Cournoyer ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Pain Relief ◽  
Acute Pain ◽  
Pain Medication ◽  
Accurate Assessment ◽  
Pain Level ◽  
Pain Problem ◽  
Effective Pain Relief ◽  
Simple Query

AbstractObjectiveThe management of acute pain constitutes an essential skill of emergency department (ED) physicians. However, the accurate assessment of pain intensity and relief represents a clinically challenging undertaking. Some studies have proposed to define effective pain relief as the patient’s refusal for additional analgesic administration. The aim of this study was to verify whether such a refusal is effectively indicative of pain relief.MethodsThis prospective cohort study included ED patients who received single or multiple doses of pain medication for an acute pain problem. Patients were evaluated for pain relief using one Likert scale and two dichotomous questions: Is your pain relieved? and Do you want more analgesics? Non-relieved patients were further analysed using a checklist as to the reasons behind their refusal for supplemental pain medication.ResultsWe have recruited 378 adult patients with a mean age of 50.3 years (±19.1); 60% were women and had an initial mean pain level of 7.3 (±2.0) out of 10. We observed that 68 out of 244 patients who were adequately relieved from pain asked for more analgesics (28%), whereas 51 out of 134 patients who were not relieved from pain refused supplemental drugs (38%). Reasons for refusal included wanting to avoid side effects, feeling sufficiently relieved, and disliking the medication’s effects.ConclusionOver a third of ED patients in acute pain were not relieved but refused supplemental pain medication. Patients have reported legitimate reasons to decline further analgesics, and this refusal cannot be used as an indication of pain relief.

scholarly journals Quantity of opioids consumed following an emergency department visit for acute pain: a Canadian prospective cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e022649 ◽  
Author(s):  
Raoul Daoust ◽  
Jean Paquet ◽  
Alexis Cournoyer ◽  
Éric Piette ◽  
Judy Morris ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Abdominal Pain ◽  
Acute Pain ◽  
Prospective Cohort ◽  
Renal Colic ◽  
Medication Use ◽  
Pain Medication ◽  
Pain Condition

ObjectivesPrescription opioid diversion is a significant contributor to the opioid misuse epidemic. We examined the quantity of opioids consumed by emergency department (ED) discharged patients after treatment for an acute pain condition (musculoskeletal, fracture, renal colic, abdominal pain and other), and the percentage of unused opioids available for potential misuse.DesignProspective cohort study.SettingTertiary care trauma centre academic hospital.ParticipantsA convenience sample of patients ≥18 years who visited the ED for an acute pain condition (≤2 weeks) and were discharged with an opioid prescription. Patients completed a 14-day paper diary of daily pain medication use. To reduce lost to follow-up, participants also responded to standardised phone interview questions about their previous 14-day pain medication use.OutcomesQuantity of morphine 5 mg tablets (or equivalent) prescribed, consumed and unused during a 14-day follow-up. Quantity of opioids to adequately supply 80% of patients for 2 weeks and 95% of patients for the first 3 days was also calculated.ResultsResults for 627 patients were analysed (mean age ±SD: 51±16 years, 48% women). Patients consumed a median of seven tablets of morphine 5 mg (32% of the total prescribed opioids). The quantity of opioids to adequately supply 80% of patients for 2 weeks was 20 tablets of morphine 5 mg for musculoskeletal pain, 30 for fracture, 15 for renal colic or abdominal pain and 20 for other pain conditions. The quantity to adequately supply 95% of patients for the first 3 days was 15 tablets of morphine 5 mg.ConclusionsPatients discharged from the ED with an acute pain condition consumed a median of fewer than 10 tablets of morphine 5 mg (or equivalent). ED physicians should consider prescribing a smaller quantity of opioids and asking the pharmacist to dispense them in portions to minimise unused opioids.Trial registration numberNCT02799004; Results.

scholarly journals Assessment of the implementation of a nurse-initiated pain management protocol in the emergency department

2021 ◽  
Vol 74 (3) ◽  
Author(s):  
Marcia Boessio dos Santos ◽  
Cristiana Maria Toscano ◽  
Ruth Ester Assayag Batista ◽  
Elena Bohomol
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Pain Management ◽  
Intervention Group ◽  
Pain Medication ◽  
Pain Level ◽  
Protocol Adherence ◽  
Management Protocol ◽  
Emergency Department Patients ◽  
Analgesic Administration

ABSTRACT Objectives: to assess the implementation of a nurse-initiated pain management protocol for patients triaged as semi-urgent, and its impact in pain intensity, in the Emergency Department. Methods: a prospective cohort study for adult patients with pain who had been triaged as semi-urgent and admitted to the hospital’s Emergency Department. Patients who received the intervention (pain-management protocol with analgesic administration) were compared to those who were managed using the conventional approach (physician evaluation prior to analgesic administration). Results: of the 185 patients included, 55 (30%) received the intervention, and 130 (70%) were managed conventionally. Patients in the intervention group were more likely to have taken pain medication in the 4 hours prior to admission, and reported higher levels of pain at admission and more significant reductions in pain level. Conclusions: despite low protocol adherence, the intervention resulted in higher reported pain relief.

scholarly journals Administration of Nebulized Ketamine for Managing Acute Pain in the Emergency Department: A Case Series

2020 ◽  
Vol 4 (1) ◽  
pp. 16-20 ◽  
Author(s):  
Jefferson Drapkin ◽  
Aidin Masoudi ◽  
Mahlaqa Butt ◽  
Rukhsana Hossain ◽  
Antonios Likourezos ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chronic Pain ◽  
Pain Relief ◽  
Acute Pain ◽  
Case Series ◽  
Effective Pain Relief

Ketamine administration in sub-dissociative doses in the emergency department (ED) results in effective pain relief in patients with acute traumatic and non-traumatic pain, chronic pain, and opioid-tolerant pain. This case series describes five adult ED patients who received nebulized ketamine for predominantly acute traumatic pain. Three patients received nebulized ketamine at 1.5 milligrams per kilogram (mg /kg) dose, one patient at 0.75 mg/kg, and one patient at 1 mg/kg. All five patients experienced a decrease in pain from the baseline up to 120 minutes. The inhalation route of ketamine delivery via breath-actuated nebulizer may have utility for managing pain in the ED.

Pain Medication Administered and Prescribed to Patients With an Ankle Sprain Treated in an Emergency Department: A Record-Based Cohort Study

2021 ◽  
Author(s):  
Kyle B. Kosik ◽  
Lucy C. Bowers ◽  
Matthew C. Hoch ◽  
Roger L. Humphries ◽  
Morgan P. Thurza ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Ankle Sprain ◽  
Pain Medication

scholarly journals Opioid Use During the Six Months After an Emergency Department Visit for Acute Pain: A Prospective Cohort Study

2020 ◽  
Vol 75 (5) ◽  
pp. 578-586 ◽  
Author(s):  
Benjamin W. Friedman ◽  
Lorena Abril Ochoa ◽  
Farnia Naeem ◽  
Hector R. Perez ◽  
Joanna L. Starrels ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Emergency Department Visit ◽  
Acute Pain ◽  
Prospective Cohort ◽  
Opioid Use

scholarly journals Opioid and non-opioid pain relief after an emergency department acute pain visit

CJEM ◽  
2021 ◽  
Author(s):  
Raoul Daoust ◽  
Jean Paquet ◽  
Alexis Cournoyer ◽  
Éric Piette ◽  
Judy Morris ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Relief ◽  
Acute Pain

scholarly journals LO10: Quantity of opioid to prescribe for acute pain to limit misuse after emergency department discharge

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S30-S31
Author(s):  
R. Daoust ◽  
J. Paquet ◽  
E. Piette ◽  
J. Morris ◽  
A. Cournoyer ◽  
...  
Keyword(s):  
Pain Relief ◽  
Neck Pain ◽  
Acute Pain ◽  
Rating Scale ◽  
Final Diagnosis ◽  
Numeric Rating Scale ◽  
Pain Medication ◽  
Urban Hospital ◽  
Opioid Prescription ◽  
Emergency Department Discharge

Introduction: A 2008 survey found that 1.9% of the entire US population was using prescription pain medication non-medically and that 56% obtained them from a friend or relatives. Diversion of pain medication may occur when a portion of the prescription is unused for pain relief after an ED visit. We hypothesized that at least 10 pills (~40%) of an opioid prescription 2 weeks after an ED visit, will not be consumed and become available for potential misuse. Objective: Determine the quantity of unused opioids pills for common acute pain diagnoses, 2 weeks after an ED visit for acute pain. Methods: Prospective observational cohort study of consecutive ED patients from a tertiary academic urban hospital with 60,000 ED visits annually. Inclusion criteria: aged ≥18 years, acute pain conditions present ≤2 weeks, pain intensity at triage of ≥4 (on a 0-10 numeric rating scale; NRS), and discharged with a new opioid prescription. ED physicians identified (24/7) eligible patients. They recorded the pain complaint/location, the final diagnosis, the quantity and type of prescribed pain medication. Discharged patients completed paper or electronic 14-day diary (REDCap database) to document their pain medication consumption. As a mitigation strategy, they were also contacted by phone at 2 weeks for the same information. A paired t-test was used to test the difference between the amounts of opioids prescribed and consumed. Results: 350 patients were recruited. Mean age 50 (SD ±16) and 54.2% were men. Painful diagnosis: fracture (18.2%), acute back pain (15.3%), renal colic (15.3%), Sprain (excluding back/neck pain) (6.9%), Contusion (6.4%), acute neck pain (5.8%), abdominal pain (4.9%), and other (27.2%). Opioids prescribed: oxycodone (47%), morphine (37%) and hydromorphone (16%). Means quantity of opioid pills prescribed: 24 (IC95%: 23-26). Filled opioid prescription: 92%. Means quantity of opioid pills consumed: 8 (IC95%: 7-9). Means quantity of unused opioids pills: 16. Opioid pills available for misuse in our cohort: 5,600 pills. Conclusion: After an ED visit for acute pain a significant portion of opioids prescribed is unused and available for misuse. A large pragmatic study should be done to confirm that an opioid prescription strategy based on our results will limit unused opioid pills while maintaining pain relief.

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