Changing Attitudes About Pain and Pain Control in Emergency Medicine

Fosnocht, David E.; Swanson, E. R.; Barton, Erik D.

doi:10.1016/j.emc.2004.12.003

Cited by 108 publications

(76 citation statements)

References 36 publications

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“…1,2 Despite the fact that so many patients visit the ED for pain, pain is often poorly or undertreated, 3,4 One of the primary reasons for this is that the assessment of pain and clinically significant changes in pain is complex, and not all of the factors involved, both in terms of the patient and the assessor, are fully understood. 5,6 Acute pain is subjectively assessed, and there is not yet a way to objectively measure the amount of suffering a patient is experiencing from pain.…”

mentioning

confidence: 99%

Gender Differences in Patient-described Pain, Stress, and Anxiety Among Patients Undergoing Treatment for Painful Conditions in the Emergency Department

et al. 2014

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Objectives: The primary objective of this study was to determine whether patient-described pain correlates with patient-described stress, anxiety, and satisfaction with ongoing treatment and if that correlation differs by gender.Methods: This was a prospective observational study at an urban, Level I trauma center conducted between June 1, 2010, and January 1, 2013. Patients reporting pain rated greater than 3 of 10 were eligible. Patients who qualified and consented for participation completed demographic and pain, anxiety, stress, and satisfaction scales at baseline, every 30 minutes, and at discharge. Data were analyzed using analysis of variance, chi-square tests, t-tests, multiple regression, and the WilcoxonMann-Whitney rank test.Results: A total of 7,124 patients were screened for enrollment. Of those, 3,495 (49%) did not qualify at screening for various reasons, including insufficient pain levels (17.5%), elected not to participate (37.7%), did not qualify for other reasons (12.4%), and reason not captured (32.4%). A total of 3,629 (51%) screened patients were eligible and consented. Of those, 620 (16.8%) did not have any data collected past baseline, leaving 3,009 as the final sample size. The patients completing data collection had a median age of 39 years (range = 18 to 90 years), and 50% were male. The mean presenting pain visual analog scale (VAS) score was 71.5 mm. Presenting stress and anxiety VAS scores were significantly higher in females (0.61 and 0.53, respectively) than males (0.56 and 0.50, respectively), whereas presenting pain VAS (0.71 male and 0.72 female) and satisfaction VAS (0.34 male and 0.35 female) did not differ by sex. Ethnicity, education, and income were all statistically different when compared with baseline pain, stress, anxiety, and satisfaction. Male gender was associated with a significant change in pain over time from baseline (coefficient = 0.040, p = 0.037); however, when adjusting for age, ethnicity, education, and income, and for changes in stress, anxiety, and satisfaction VAS scores, changes in pain related to male gender was no longer significant (coefficient = 0.034, p = 0.11). When asked about their satisfaction with the results of the pain treatment that had been provided, patients reported a median of 2 (out of 6, 1 = satisfied, 6 = dissatisfied; interquartile range = 1 to 2). There was no significant difference between sexes (p > 0.90).Conclusions: Patient-reported stress and anxiety were higher among female patients than male patients, but there was no significant difference in reported pain and satisfaction between sexes. Sex alone was not a significant predictor of change in pain for patients presenting to the emergency department with pain-related complaints. Anxiety and stress may potentially influence the pain-gender relationship.

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confidence: 99%

Gender Differences in Patient-described Pain, Stress, and Anxiety Among Patients Undergoing Treatment for Painful Conditions in the Emergency Department

et al. 2014

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“…However, until each physician assumes leadership in pain management, the issues of "oligoanalgesia" will persist. 52 Improvements in pain assessment and documentation, progress in knowledge and research, changes in attitude toward "opiophobia", recognition of ethnic, racial, and age differences in patients with pain, will all contribute to effective management of pain in the ED. ED physicians must recognize that pain is a true emergency and treat it as such.…”

Section: Resultsmentioning

confidence: 99%

Problems and barriers of pain management in the emergency department: Are we ever going to get better?

Motov

Khan

2008

JPR

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Pain is the most common reason people visit emergency rooms. Pain does not discriminate on the basis of gender, race or age. The state of pain management in the emergency department (ED) is disturbing. ED physicians often do not provide adequate analgesia to their patients, do not meet patients' expectations in treating their pain, and struggle to change their practice regarding analgesia. A review of multiple publications has identifi ed the following causes of poor management of painful conditions in the ED: failure to acknowledge pain, failure to assess initial pain, failure to have pain management guidelines in ED, failure to document pain and to assess treatment adequacy, and failure to meet patient's expectations. The barriers that preclude emergency physicians from proper pain management include ethnic and racial bias, gender bias, age bias, inadequate knowledge and formal training in acute pain management, opiophobia, the ED, and the ED culture. ED physicians must realize that pain is a true emergency and treat it as such.

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“…8,9 Healthcare providers in general may benefit from pain education programs to provide satisfactory pain management in the ED regardless of their level of training or years of experience. 10,11 Some studies state that patients of all ages have no gender preference for the provider who performs procedures such as pelvic examinations. 5 In our analysis there was a trend of better patient satisfaction with procedure-related pain management scores when female ED providers delivered care.…”

Section: Discussionmentioning

confidence: 99%

Impact of Emergency Department Provider Training on Patient Satisfaction with Procedure-Related Pain Management

Nagurka¹,

Lamba²,

Hoonpongsimanont³

et al. 2016

Res Dev Med Edu

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Changing Attitudes About Pain and Pain Control in Emergency Medicine

Cited by 108 publications

References 36 publications

Gender Differences in Patient-described Pain, Stress, and Anxiety Among Patients Undergoing Treatment for Painful Conditions in the Emergency Department

Gender Differences in Patient-described Pain, Stress, and Anxiety Among Patients Undergoing Treatment for Painful Conditions in the Emergency Department

Problems and barriers of pain management in the emergency department: Are we ever going to get better?

Impact of Emergency Department Provider Training on Patient Satisfaction with Procedure-Related Pain Management

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