"Why haven't you taken any pain killers?" A patient focused study of the walking wounded in an urban emergency department

Abstract

Objectives: (1) To assess the proportion of patients of triage category 3-5 presenting to the minor side of an urban emergency department who present without taking prior pain relief, and (2) to describe the reasons why they do not take pain relief for their presenting complaint Method: By patient interview of a convenience sample of 60 adult patients in the setting of an urban emergency department. Results: Fifteen of 60 patients had taken analgesia and 45 of 60 (75%) had not. Sixteen reasons were volunteered to the interviewer. Most patients offered one reason only 39 of 45 (87%). The three commonest single reasons cited for not taking pain relief were "don't like taking tablets" 10 (22%), "run out of tablets" 10 (22%), five (11%) said their "pain not bad enough". Six (13%) patients cited two reasons for not taking pain relief. Only three (6%) patients indicated that they "did not think about pain relief". Six (13%) of patients had inappropriate perceptions of how pain killers may interfere with their care. Conclusion: Most patients presenting with painful conditions to the minor side of an urban emergency department had not taken pain relief. The study highlights there are many different reasons for this and staff should not presume that it was because the patient "did not think about it". Ongoing education of staff and patients is needed.

Do Patients with Recurrent Headaches Attempt Abortive Therapy Before Their Emergency Department Visit?

“…Enrollment was limited to a convenience sample of 60 adult patients. This study is analogous to ours, as it identified a significant number of patients not attempting analgesic medications before ED arrival, although Nicol and Ashton-Cleary's results were more pronounced (12).…”

Patterns of analgesia for fractured neck of femur in Australian emergency departments

“…Pain is one of the most common presenting complaints in ED and timely and effective analgesia should be one of the major goals of good emergency care. [1][2][3] Untreated severe pain can increase patient fear and anxiety, lead to aggressive behaviour and disturbance of cognition, and have a detrimental effect on physiological parameters. 4,5 However, studies examining analgesia in ED have consistently demonstrated that slow and sub-therapeutic pain relief remains a persistent problem.…”

Analgesic usage and reasons for emergency department attendance in ambulatory care patients with minor injury

“…The study instrument was a written survey containing 13 questions (). The list of possible reasons for not having taken prior analgesia (Question 4) was derived largely from a UK study in which patients were asked an open‐ended question by an interviewer regarding why they had not taken analgesia 1 . Further possible reasons were added based on the author's experience of reasons given by patients in Australasian EDs.…”

“…It was calculated that the study needed to recruit 459 patients, in order that a 15% true difference in primary reason for attending between the two groups (no prior analgesia vs prior analgesia) could be detected with 80% power. A 3:1 ratio of people taking no analgesia before attendance compared with people having taken analgesia was used for this calculation, based on Nichol and Ashton‐Cleary's study in which 75% of participants had not taken analgesia before presentation 1 . In another study 56% took analgesia and 44% didn't 12 .…”

“…Patients with minor injury frequently present to the ED in pain, but without having taken any prior analgesia 1 . This can be frustrating for ED medical staff if they believe self‐administration of analgesia would have obviated the need for an ED visit.…”