Patients' perspectives on the insufficiency of scales to rate their pain in the ED

Göransson, Katarina E.; Heilborn, Umut; Djärv, Therese

doi:10.1016/j.ajem.2016.08.068

Cited by 4 publications

(4 citation statements)

References 3 publications

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“…Smith et al 46 reported that patients wished physicians would delve deeper into the functional impairment and what pain means for the patient rather than focusing on the 0-to-10 pain scale. Goransson et al 47 reported that ED patients were unsure of the ability of the pain scale to reflect their pain because of subjectivity of pain, difficulty in rating fluctuating pain, missing details of settings or history of pain, and difficulty in imagining what maximum pain would feel like. However, as a reminder to assess pain severity and highlight a need for analgesia, mandating the use of pain scores appeared to be of value in guiding staff to undertake assessment.…”

Section: Discussionmentioning

confidence: 99%

The Reality of Pain Scoring in the Emergency Department: Findings From a Multiple Case Study Design

Sampson

Goodacre

O’Cathain

2019

Annals of Emergency Medicine

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Background: At times of increasing pressure on emergency departments, and the need for research into different models of service delivery, little is known about how to recruit patients for qualitative research in emergency departments. We report from one study which aimed to collect evidence on patients' experiences of attending emergency departments with different models of general practitioners, but faced challenges in recruiting patients. This paper aims to identify and reflect on the challenges faced at all stages of patient recruitment, from identifying and inviting eligible patients, consenting them for participation and finally to engaging them in interviews and make recommendations based on our learning. Methods: A thematic analysis was carried out on field-notes taken during research visits and meeting minutes of discussions to review and improve patient recruitment throughout the study. Results: The following factors influenced the success of patient recruitment in the emergency department setting: complicated or time-consuming electronic health record systems for identifying patients; narrow participant eligibility criteria; limited research nurse support; and lack of face-to-face communication between researchers and eligible patients. Conclusions: This paper adds to the evidence for improving patient recruitment in different settings, with a focus on qualitative research in emergency departments. Our findings have implications for future studies attempting to recruit patients in similar settings.

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Section: Discussionmentioning

confidence: 99%

The Reality of Pain Scoring in the Emergency Department: Findings From a Multiple Case Study Design

Sampson

Goodacre

O’Cathain

2019

Annals of Emergency Medicine

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“…509 records were analyzed through title and abstract screening and 495 records were excluded, with a total of 14 records remaining for full text screening [26][27][28][29][30][31][32][33][34][35][36][37][38]. Additional 336 papers were retrieved by citation tracking, of which 11 full-text records were assessed [9,29,[39][40][41][42][43][44][45][46][47]. None of the studies met the criteria for the primary outcome.…”

Section: Study Selectionmentioning

confidence: 99%

Multidimensional versus unidimensional pain scales for the assessment of analgesic requirement in the emergency department: a systematic review

Crisman,

Appenzeller-Herzog,

Tabakovic

et al. 2024

Intern Emerg Med

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Pain is a multidimensional experience, potentially rendering unidimensional pain scales inappropriate for assessment. Prior research highlighted their inadequacy as reliable indicators of analgesic requirement. This systematic review aimed to compare multidimensional with unidimensional pain scales in assessing analgesic requirements in the emergency department (ED). Embase, Medline, CINAHL, and PubMed Central were searched to identify ED studies utilizing both unidimensional and multidimensional pain scales. Primary outcome was desire for analgesia. Secondary outcomes were amount of administered analgesia and patient satisfaction. Two independent reviewers screened, assessed quality, and extracted data of eligible studies. We assessed risk of bias with the ROBINS-I tool and provide a descriptive summary. Out of 845 publications, none met primary outcome criteria. Three studies analyzed secondary outcomes. One study compared the multidimensional Defense and Veterans Pain Rating Scale (DVPRS) to the unidimensional Numerical Rating Scale (NRS) for opioid administration. DVPRS identified more patients with moderate instead of severe pain compared to the NRS. Therefore, the DVPRS might lead to a potential reduction in opioid administration for individuals who do not require it. Two studies assessing patient satisfaction favored the short forms (SF) of the Brief Pain Inventory (BPI) and McGill Pain Questionnaire (MPQ) over the Visual Analogue Scale (VAS) and the NRS. Limited heterogenous literature suggests that in the ED, a multidimensional pain scale (DVPRS), may better discriminate moderate and severe pain compared to a unidimensional pain scale (NRS). This potentially impacts analgesia, particularly when analgesic interventions rely on pain scores. Patients might prefer multidimensional pain scales (BPI-SF, MPQ-SF) over NRS or VAS for assessing their pain experience.

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“…The VAS and the NRS have both been evaluated for use in the ED (Bahreini, Jalili, & Moradi-Lakeh, 2015;Bijur, Latimer, & Gallagher, 2003;Bijur, Silver, & Gallagher, 2001;Göransson, Heilborn, & Djarv, 2016;Williamson & Hoggart, 2005). The NRS is easier to use since no equipment is needed and, therefore, it might be more suitable to use in the ED (Göransson et al, 2016;Williamson & Hoggart, 2005). The choice between the VAS and the NRS can therefore be based on subjective preferences (Breivik, Bjornsson, & Skovlund, 2000).…”

Section: Assessment Of the Patient's Acute Painmentioning

confidence: 99%

“…Both the VAS and the NRS are valuated to measure pain in the ED setting (Göransson et al, 2016). A pilot test of the developed questionnaire was done in the surveyed patient group before the survey was conducted.…”

Section: Data Collectionmentioning

confidence: 99%

Mandatory documentation of pain in the emergency department increases analgesic administration but does not improve patients’ satisfaction of pain management

Sturesson

Falk

Castrèn

et al. 2016

Scandinavian Journal of Pain

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AbstractBackgroundPain is one of the most common symptoms treated in emergency department (ED). Pain may cause suffering and disability for the patient. Inadequate pain management may be associated with increased risk of complications such as sleep disturbance, delirium and depression. Previous studies conclude that pain management in ED is insufficient and inadequate. Yet, little is known about patients’ own experience regarding pain management in ED.ObjectiveThe aim of this study was to explore the satisfaction of pain management in patients having acute musculoskeletal injuries before and after implementation of mandatory documentation regarding pain assessment in the ED.MethodAn observational pre-post intervention study design was used. The study was conducted on patients having acute musculoskeletal injuries such as soft tissue injury, back pain or wrist/arm/leg/foot fractures in a 24-h adult (>15 years) ED at a public urban teaching hospital in Stockholm, Sweden. Data was collected by an interview based on a questionnaire.ResultsA total of 160 patients answered the questionnaire. In the pre- (n = 80) and post-intervention (n = 80) groups, 91/95% experienced pain in the ED. A significant difference (p < 0.003) was found during the post-intervention period, with more patients receiving analgesics compared to the pre-intervention group. A significant decline (p < 0.03) in patients’ own reported pain intensity at discharge was found between the groups. Patients’ reported satisfaction on pain management in the ED increased in the post-intervention group, but the difference was not statistically significantly.ConclusionPatients’ satisfaction with pain management increased, but not statistically significantly. However, both percentages of patients receiving analgesic drugs increased and pain intensity decrease at discharge were statistically significant after the intervention that made nurses obliged to register pain.Implication According to the findings of this study, mandatory pain documentation facilitates pain management in the ED, but there is still room for improvement. Additional actions are needed to improve patients’ satisfaction on pain management in the ED. Mandatory pain documentation in combination with person-centred care could be a way of improving patients’ satisfaction on pain management. Effective pain management is an important quality measure, and should be focused on in acute care in the ED. By routinely asking patients to report the pain intensity at discharge, the ED personnel can have direct feedback about the factual pain management. RNs may also be encouraged to use intravenous analgesics in higher extent when the patients have very severe pain.

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Patients' perspectives on the insufficiency of scales to rate their pain in the ED

Cited by 4 publications

References 3 publications

The Reality of Pain Scoring in the Emergency Department: Findings From a Multiple Case Study Design

The Reality of Pain Scoring in the Emergency Department: Findings From a Multiple Case Study Design

Multidimensional versus unidimensional pain scales for the assessment of analgesic requirement in the emergency department: a systematic review

Mandatory documentation of pain in the emergency department increases analgesic administration but does not improve patients’ satisfaction of pain management

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