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

Motov, Sergey; Khan, Abu N.G.A.

doi:10.2147/jpr.s4324

Cited by 78 publications

(4 citation statements)

References 60 publications

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“…The gender distribution was the same, the mean age was similar in our study and the mean pain intensity was similar [3] [6] [7] [8]. Our data are inferior to those of Guéant S et al [9] who Open Journal of Emergency Medicine…”

Section: Discussionsupporting

confidence: 53%

Evaluation of the Effectiveness and Nature of Analgesia in the Medical-Surgical Emergency Department of CHU-Donka

Camara,

Touré,

Bangoura

et al. 2023

OJEM

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Introduction: Pain assessment is an essential step towards pain relief. In our context, however, it is insufficient in emergency departments. The aim was to assess the nature and effectiveness of the analgesia used in the emergency department of the CHU-Donka. Method: This was a single-centre prospective observational study conducted over one month (November 2020) in the medical-surgical emergency department of CHU-Donka. All patients aged 18 or over admitted to the emergency department with moderate to severe acute pain were included. Results: We enrolled 880 patients, 615 of whom (69.88%) were in pain. Males predominated (65.2%), with a sex ratio of 1.87. The average age was 44.78 ± 16.41 years, with extremes ranging from 18 to 85 years. The most represented age group was 18 -34 years, with 66.18%. Initial assessment of pain by nursing staff in 3 cases. Initial assessment of pain by the investigator was 100%, 74% moderate and 26% severe. No reassessment of pain by nursing staff. Reassessment by the interviewer was 100% and found 5% no pain, 61% mild pain, 24% moderate pain and 10% severe pain. With an average numerical scale of 3.77 ± 2.61 and extremes from 0 to 10. Average length of stay was 2.85 ± 1.48 hours, with extremes ranging from 45 minutes to 8 hours. Analgesia was administered with paracetamol alone (43.58%), combined with tramadol or nefopam. No patient received morphine. Conclusion: This study revealed a lack of pain assessment in our department.

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Section: Discussionsupporting

confidence: 53%

Evaluation of the Effectiveness and Nature of Analgesia in the Medical-Surgical Emergency Department of CHU-Donka

Camara,

Touré,

Bangoura

et al. 2023

OJEM

View full text Add to dashboard Cite

show abstract

“…Although this review focused on contemporary studies to reflect contemporary practice, the tools cited are quite dated and may not be relevant to current clinical practice and settings when compared with their development forty years ago. Factors such as patient knowledge via internet, patient expectation, along with new medications and changes to clinical management, influence current care delivery in the ED (Motov & Khan, 2008).…”

Section: Discussionmentioning

confidence: 99%

Adult pain and anticipatory anxiety assessment in the emergency department: An integrative literature review

McCahill

Keogh

Hughes

2022

Journal of Clinical Nursing

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Introduction Patients presenting to the emergency departments in pain often experience co‐occurring symptoms. Anticipatory anxiety in the emergency department may be currently under‐recognised. Clinical tools to facilitate the assessment of co‐occurring symptoms aligns with providing more patient centred care and improved outcomes and experience. Aims This integrative review aimed to identify and examine the psychometric properties of tools currently used for pain and anticipatory anxiety assessment in adult patients presenting to the emergency department. This study also aimed to identify the current clinical practice used to assess adult pain and anticipatory anxiety. Methods Whittemore and Knafl's methodology guided the review process, and it is reported according to relevant items from PRISMA checklist. Studies were included if they focused on tools for pain or anxiety assessment of adults in emergency departments in English language publications since 2010. Quality of studies was evaluated using the Mixed Methods Appraisal Tool (MMAT). The results were summarised through narrative synthesis. Results A total of 15 studies were identified for narrative synthesis. Six tools for pain, and four tools for anticipative anxiety were found. All currently used clinical tools assess symptoms in isolation. There was limited discussion of the clinical context of identified tools within the included studies. Conclusion Pain and anxiety assessment are currently performed in symptom isolation with a variety of tools with varying degrees of reliability. There exists a lack of clinical tools able to assess co‐occurring symptoms of pain and anticipatory anxiety in the clinical setting of the emergency department. No studies discussed clinical tool use in current practice. Relevance to Clinical Practice The reconstruction of available pain and anxiety assessment tools into one validated and holistic tool for assessment in the ED clinical setting, would provide a contextually appropriate guide to clinical assessment and treatment. Acknowledging and measuring these symptoms may facilitate future rigorous testing of experimental studies of novel methods to reduce pain and anxiety in the ED. No Patient or Public Contribution Patient or public contribution does not apply to this Integrative Review. Clinical Trial Registration Number Not applicable.

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“…Table 2 gives a brief about the potential causes and biases of Oligoanalgesia in an emergency setting. 6 In an emergency setting, it is the onus of the healthcare professional to assess and manage the patients' symptoms appropriately. Hence it becomes paramount that the healthcare practitioner should consider all the factors mentioned in above table, both patient and doctor-related, when treating any patient in the emergency setting.…”

Section: Causes Of Oligoanalgesia In Emergency Settingsmentioning

confidence: 99%

“…Potential factors for Oligoanalgesia in an emergency setting: 6,7. Pain is assumed to be an expected byproduct of trauma and ignored Management of other symptoms take priority over pain management Studies over the years have shown that only 60% of patients received analgesics with delays up to 90 min.…”

mentioning

confidence: 99%

Oligoanalgesia in the emergency setting – An Indian review

Vijayvargiya

Panchal

Asawale

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Pain is a result of nociceptive tissue injury and results in acute and chronic impact to patients. Acute pain management is the need of the hour as untreated or under-treated pain may progress to chronic pain. Pain irrespective of its temporality causes a negative impact on the quality of life of the patients. Many Indian emergency settings are not adequately equipped to handle pain due to the heavy load of patients and the lack of awareness about the pain management guidelines. This leads to undertreatment of pain or 'oligoanalgesia'. A pain management protocol can help prevent oligoanalgesia in an emergency setting. Proper utilization of triage systems that incorporate pain as one of the vital signs is necessary. The categorization of pain with the help of a pain scale helps determine the severity of pain and its appropriate management. Pain management is an ongoing process that does not end with the discharge of the patient. Post discharge management of pain is also an important factor to prevent chronic pain. This may involve various modalities for pain management under the preview of multimodal management of pain.

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

Cited by 78 publications

References 60 publications

Evaluation of the Effectiveness and Nature of Analgesia in the Medical-Surgical Emergency Department of CHU-Donka

Evaluation of the Effectiveness and Nature of Analgesia in the Medical-Surgical Emergency Department of CHU-Donka

Adult pain and anticipatory anxiety assessment in the emergency department: An integrative literature review

Oligoanalgesia in the emergency setting – An Indian review

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