Effectiveness of pain management in patients with musculoskeletal trauma

More information: Jorien Pierik, MSc PhD candidate

W: www.utwente.nl/mb/htsr E: J.G.J.Pierik@utwente.nl

Fracture Luxation Distortion Contusion

EFFECTIVENESS OF PAIN MANAGEMENT IN PATIENTS

WITH MUSCULOSKELETAL TRAUMA

Pain intensity at ED admission and ED discharge. Mean pain score was NRS 6.5 (SD=2.4) at admission and 5.7 (SD=2.5) at discharge. Pain management in the ED. In total, 77% of patients received non‐ pharmacological and 37% pharmacological treatment during ED‐visit. The number of counts in patients that received pharmacological pain management increased as pain intensity at arrival was more intense. Pharmacological pain management provided by referrer in the prehospital phase. In the prehospital phase, less than one‐fifth of the 111 patients who were referred by health professionals received pain medication; forty percent of the 22 patients arriving by ambulance received medication and one‐fifth of 115 self‐referrals took self‐medication

BACKGROUND AND AIM

STUDY DESIGN AND POPULATION

1.University Twente, Health Technology & Services Research, MIRA institute for Biomedical Technology and Technical Medicine, Enschede 2. Radboud University Nijmegen, Regional Emergency Healthcare Network, Nijmegen 3. University Medical Center Utrecht, Emergency Department, Utrecht, 4. Medisch Spectrum Twente, Emergency Department and Department of Surgery, Enschede. The Netherlands

Pierik JGJ

1

_{, IJzerman MJ}

1

_{, Berben SA}

2

_{, Heurman G}

1

_{, Gaakeer MI}

3

_{, van Vugt AB}

4

_{, Doggen CJM}

1

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Acute pain following traumatic injury is one of the most frequent reasons why patients are seeking medical care.

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While acute pain is the most frequent complaint in emergency care, its management is often neglected, placing

patients at risk of oligoanalgesia.

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Our aim is to investigate how often pain management is provided in the prehospital phase and in the Emergency

Department (ED) and how this affects pain relief.

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This prospective cohort study (PROTACT) includes 248 adult patients presenting with acute musculoskeletal pain

caused by blunt trauma of the extremities to the ED of Medisch Spectrum Twente, Enschede, The Netherlands

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Data regarding pain and pain management were collected in prehospital and ED‐setting using registries and

questionnaires

RESULTS

DISCUSSION

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An insufficient proportion of patients receives pain management and pain relief remains unsatisfactory.

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The importance of pharmacological pain management in ED is reflected in the proportion of patients with clinical

pain reduction during ED‐visit.

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Effective pain management is important, it leads to earlier mobilization and recovery and may prevent long‐term

consequences as chronic pain.

0 20 40 60 80 100 No pain Minimal pain Mild pain Moderate pain Severe pain Very severe pain N umber  of  pa tien ts  (n) Pain intensity at admission in ED Very severe pain (NRS 9‐10) Severe pain (NRS 7‐8) Moderate pain (NRS 5‐6) Mild pain (NRS 3‐4) Minimal pain (NRS 1‐2) No pain (NRS 0) At ED discharge 0 25 50 75 100 125 Self‐referrer By other health proffesionals By ambulance services N umber  of  pa tien ts Pharmacological pain management No pharmocological pain management 0 25 50 75 100 125 No pain Minimal pain Mild pain Moderate pain Severe pain Very severe pain N umber  of  pa tien

ts Non‐pharmacological pain management in ED

No treatment Treatment Effect of pain management in the ED. Patient who receive no pain management had a mean pain reduction of 0.54. Patient who had both non‐and pharmaco‐ logical pain management (1.42), with only non‐pharmacological (0.58) and only pharmacological (1.11) reduction. Patients who received pharmacological pain management at ED had higher pain reduction: 1.33 vs. 0.57 (difference 0.76; 95%CI 0.37‐1.13) than patients without medication, also after adjustment for pain at admission. Only one‐quarter of patients had a clinical effective (2‐ points) pain reduction during ED‐visit: 39% of those receiving pain medication vs. 18% who did not receive medication. 0% 20% 40% 60% 80% 100% No pharmacological treatment in ED Pharmacological treatment in ED No clinical effective reduction Clinical effective reduction 0 25 50 75 100 125 No pain Minimal pain Mild pain Moderate pain Severe pain Very severe pain N umber  of  pa tien ts Pharmacological pain management in ED No treatment Treatment Mean -0.54 -1.42 -1.11 -0.58