Patient and physician agreement on abdominal pain severity and need for opioid analgesia

Thomas, Stephen; Borczuk, Pierre; Shackelford, Jay; Ostrander, James; Silver, David; Evans, Michael L.; Stein, Joshua D.

doi:10.1016/s0735-6757(99)90203-6

Cited by 39 publications

(23 citation statements)

References 3 publications

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“…Although the usual methods for estimating pain, such as numerical rating scale [1] or a visual analogue scale [2], have been validated, the clinical impact of their use is uncertain. Clinicians continue in many cases to be insufficiently aware of patients' pain [3][4][5][6][7] and to rate it at lower levels than do patients themselves, for both acute [8][9][10][11][12] and chronic [13] pain. When asked why they give lower ratings, clinicians explain that they are trained to look for behavioral signs of pain and that, accordingly, when they judge the behavioral evidence or the nature of the illness as ''discordant'' with the patients' stated level of pain, they will, consciously or unconsciously, adjust their own ratings in light of this conflicting information.…”

Section: Introductionmentioning

confidence: 99%

Emergency physicians’ pain judgments: cluster analyses on scenarios of acute abdominal pain

2007

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Physicians have been found to give lower ratings of patients' pain than do the patients themselves. We hypothesized that the physicians' rating depends not only on the patient's pain rating but also on other cues. We also hypothesized that these cues influence physicians' pain treatment and urgency level. We gave to 52 emergency room physicians in Toulouse, France, 45 scenarios describing patients with acute abdominal pain, representing all combinations of 5 levels of patient's pain rating, 3 levels of behavioral manifestations of pain, and three signs of the severity of the abdominal pathology (namely, the likelihood of appendicitis). The participants rated the patient's pain, selected the intensity of pain treatment, and judged the degree of urgency of calling in a surgeon. In rating pain, physicians took into account the patient's rating, behavioral manifestations of pain, and the signs of abdominal pathology. Clusters analyses showed two sets of individual differences. When rating pain and choosing pain treatment, physicians gave either a low or high weight to behavioral pain cues. In urgency judgments, physicians could be separated into those who gave considerable weight to the different levels of severity and those who did not.

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Section: Introductionmentioning

confidence: 99%

Emergency physicians’ pain judgments: cluster analyses on scenarios of acute abdominal pain

2007

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“…19,20 Studies to investigate this issue have shown that early analgesia does not hinder the recognition of surgical conditions [21][22][23][24][25][26] and that there is good agreement between physicians and patients on pain severity and need for analgesia. 27 To date, there are few studies evaluating factors that affect pain management in patients with undifferentiated abdominal pain. One study, limited by small sample size, showed that women wait longer for their medications.…”

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confidence: 99%

Gender Disparity in Analgesic Treatment of Emergency Department Patients with Acute Abdominal Pain

Chen

Shofer

Dean

et al. 2008

Academic Emergency Medicine

253

144

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Objectives: Oligoanalgesia for acute abdominal pain historically has been attributed to the provider's fear of masking serious underlying pathology. The authors assessed whether a gender disparity exists in the administration of analgesia for acute abdominal pain.Methods: This was a prospective cohort study of consecutive nonpregnant adults with acute nontraumatic abdominal pain of less than 72 hours' duration who presented to an urban emergency department (ED) from April 5, 2004, to January 4, 2005. The main outcome measures were analgesia administration and time to analgesic treatment. Standard comparative statistics were used.Results: Of the 981 patients enrolled (mean age ± standard deviation [SD] 41 ± 17 years; 65% female), 62% received any analgesic treatment. Men and women had similar mean pain scores, but women were less likely to receive any analgesia (60% vs. 67%, difference 7%, 95% confidence interval [CI] = 1.1% to 13.6%) and less likely to receive opiates (45% vs. 56%, difference 11%, 95% CI = 4.1% to 17.1%). These differences persisted when gender-specific diagnoses were excluded (47% vs. 56%, difference 9%, 95% CI = 2.5% to 16.2%). After controlling for age, race, triage class, and pain score, women were still 13% to 25% less likely than men to receive opioid analgesia. There was no gender difference in the receipt of nonopioid analgesia. Women waited longer to receive their analgesia (median time 65 minutes vs. 49 minutes, difference 16 minutes, 95% CI = 3.5 to 33 minutes).Conclusions: Gender bias is a possible explanation for oligoanalgesia in women who present to the ED with acute abdominal pain. Standardized protocols for analgesic administration may ameliorate this discrepancy.ACADEMIC EMERGENCY MEDICINE 2008; 15:414-418 ª

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“…[41][42][43][44][45][46] Clinicians' perception of patients' pain does not correlate well with self-reported pain. 17,[47][48][49] Observations of pain behavior do not correlate well with self-reports of pain. 50 Thus, clinicians must rely on self-reports of pain, when available.…”

Section: Discussionmentioning

confidence: 99%

The Verbal Numeric Pain Scale: Effects of Patient Education on Self-reports of Pain

Marco

Plewa

et al. 2006

Acad Emergency Med

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Patient and physician agreement on abdominal pain severity and need for opioid analgesia

Cited by 39 publications

References 3 publications

Emergency physicians’ pain judgments: cluster analyses on scenarios of acute abdominal pain

Emergency physicians’ pain judgments: cluster analyses on scenarios of acute abdominal pain

Gender Disparity in Analgesic Treatment of Emergency Department Patients with Acute Abdominal Pain

The Verbal Numeric Pain Scale: Effects of Patient Education on Self-reports of Pain

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