Pain prevalence and pain relief in trauma patients in the Accident &amp; Emergency department

Berben, Sivera; Meijs, T; Dongen, R.T.M. van; Vugt, A.B. van; Vloet, Lilian; Groot, Joke J. Mintjes-de; Achterberg, Theo van

doi:10.1016/j.acpain.2008.05.036

Cited by 19 publications

(44 citation statements)

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“…Berben et al (2008) emphasize however that the management of pain while the patient is in the ED has received less attention. In their study, 91% of patients reported pain on admission to the ED and 86% of patients reported pain on discharge from the ED.…”

Section: Analgesiamentioning

confidence: 95%

“…The barriers to effective pain management in the ED were described including patient anxiety and a lack of knowledge by the ED staff, both problems that could be potentially addressed to improve patient experience in the ED. It was concluded that acute pain in trauma patients is a significant problem and that pain is not treated effectively at any point during the ED experience (Berben et al, 2008).…”

Section: Analgesiamentioning

confidence: 99%

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Blunt chest wall trauma: A review

Battle

Hutchings

Evans

2013

Trauma

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Blunt chest wall trauma accounts for a large proportion of all trauma presentations to the Emergency Departments in the United Kingdom and has a high reported incidence of morbidity and mortality. The difficulty in the assessment and management of this patient group arises from the possibility that the patient may develop potentially life-threatening complications up to approximately 72 h post-injury, even in patients who have sustained what is initially considered a minor injury. Limited consensus currently exists in the literature regarding optimal assessment or management strategies for this patient group. The aim of this review is to provide an overview of current research investigating the optimal assessment and management strategies for the blunt chest wall trauma patient.

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Section: Analgesiamentioning

confidence: 95%

Section: Analgesiamentioning

confidence: 99%

Blunt chest wall trauma: A review

Battle

Hutchings

Evans

2013

Trauma

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“…6 While much of the literature testifying to pain's undertreatment in the ED has emerged from the United States, the problem is conceivably global. For instance, studies have also emerged from Canada, 7 Australia, 8 the Netherlands, 9 Israel, 10 Costa Rica, 11 the Caribbean, 12 and South Africa. 13 Indeed, the problem may well be exacerbated in some countries, where 'political conflict, social dislocation, and inadequate availability of analgesia conspire to make the relief of acute pain sporadic at best'.…”

Section: The Problemmentioning

confidence: 97%

Why is Pain Still Under‐Treated in the Emergency Department? Two New Hypotheses

et al. 2015

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Why is pain still under-treated in the emergency department? Two new hypotheses Bioethics, 2016; 30(3):195-202 © 2015 John Wiley & Sons Ltd This is the peer reviewed version of the following article: Drew Carter, Paul Sendziuk, Jaklin A. Eliott, Annette Braunack-Mayer Why is pain still under-treated in the emergency department? Two new hypotheses Bioethics, 2016; 30(3):195-202 Publishing in a subscription based journal Accepted (peer-reviewed) VersionSelf-archiving of the accepted version is subject to an embargo period of 12-24 months. The embargo period is 12 months for scientific, technical, and medical (STM) journals and 24 months for social science and humanities (SSH) journals following publication of the final article.The accepted version may be placed on:• the author's personal website • the author's company/institutional repository or archive • certain not for profit subject-based repositories such as PubMed Central as listed below Articles may be deposited into repositories on acceptance, but access to the article is subject to the embargo period. We canvass the literature testifying to this problem, the reasons why this problem is so important, and then some of the main hypotheses that have been advanced in explanation of the problem. We then argue for the plausibility of two new hypotheses: pain's under-treatment in the ED partly owes to (1) an epistemic preference for signs over symptoms on the part of some practitioners, and (2) some ED practices that themselves worsen pain by increasing patients' anxiety and fear. Our argumentation includes the 2 following logic. Some ED practitioners depart from formal guidance in basing their acute pain assessments on observable features rather than on patient reports of pain. This is potentially due to an epistemic preference for signs over symptoms which aims to circumvent intentional and/or unintentional misrepresentation on the part of patients. However, conducting pain assessments in line with this epistemic preference contributes to the under-treatment of pain in at least three respects, which we detail. Moreover, it may do little to help the practitioner circumvent any intentional misrepresentation on the part of the patient, as we explain.Second, we examine at least four ED practices that may be contributing to the under-treatment of pain by increasing patient anxiety and fear, which can worsen pain. These practices include the failure to provide orienting information and the partial objectification of patients required to problemsolve along lines pre-established by modern medical science. We conclude by touching on some potential solutions for ED practice.

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“…57 Monitoring of ICP in patients at risk of developing ACS has no significant complications, but failure to monitor may lead to a missed diagnosis. 2,10 The critical pressure that will lead to microcirculatory failure depends on the patient's blood pressure, the duration of pressure elevation, and many other local and systemic factors. 44 Both basic science and clinical studies have shown that muscle ischaemia in injured limbs generally occurs when the tissue pressure increases to within 20e30 mmHg of the diastolic pressure.…”

Section: Intracompartmental Pressure (Icp) Measurementmentioning

confidence: 99%