In 47 patients admitted to the coronary care unit (CCU) at Sahlgren's Hospital in Göteborg, Sweden, due to acute myocardial infarction (MI) the intensity of pain independently assessed by the patient and by the nurse on duty was evaluated during the first 24 hours in CCU. Pain was assessed according to a modified numerical rating scale graded from 0-10, where 0 meant no pain and 10 meant the most severe pain. A positive correlation between the patients' and nurses' assessments was found (r = 0.76; P less than 0.001). However, the nurses under-estimated the patients' pain in 23% of the situations and over-estimated it in 20%. Over-estimation was particularly found when heart rate and blood pressure increased. Many patients scoring their pain to fairly high degrees were not given pain-relieving treatment. Treatment with morphine did not cause substantial pain relief in a substantial number of patients. A significantly positive correlation was found between the patients' and nurses' assessments of pain, although under-estimation as well as over-estimation occurred. A few patients with severe pain were not treated and when treatment was given it was often ineffective.

No abstract

Summary: In 722 patients with suspected acute myocardial infarction (MI) we have tried to describe the course of chest pain according to their own assessment and morphine requirement. Patients were asked to score pain from 0-10 every second hour after arrival in the coronary care unit (CCU) and also to score their maximal pain at home. A very high intensity of chest pain was observed at home (mean score 7.1). At arrival in the CCU the mean pain score already had declined to 1.8, although 51% still had chest pain. Pain score declined successively during the first 12 hours in the CCU. At 24 hours after arrival, 20% still had some chest discomfort. In one quarter of the series a score of more than 0 was observed later than 24 hours after arrival in CCU. Patients developing definite MI had, as expected, a longer duration of pain and a much higher requirement of morphine compared with those with no MI. The difference between MI and no MI patients regarding subjective assessment of the initial intensity of pain at home and in hospital was, however, surprisingly low.