How to Manage Pain in the ER

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A simple yes/no question could be an effective tool to help patients decide for themselves whether their pain is adequately controlled, according to researchers conducting a study to evaluate the efficacy of a new evidence-based protocol to treat acute, severe pain in emergency department patients.  

Simply asking the question, "Do you want more pain medication?" resulted in satisfactory pain control in 99 percent of emergency department patients participating in the study, the researchers say. The findings are published in Annals of Emergency Medicine.

"Pain perception is highly subjective and not necessarily correlated to pain scores. Our pain protocol is a departure from the more traditional ways of assessing pain relief, which typically use the visual analogue scale or the numerical rating scale," says Andrew Chang, MD, MS of the Department of Emergency Medicine at Montefiore Medical Center in Bronx, N.Y. and one of the study's authors.

"Our simple and easy to remember '1 + 1 + 1 + 1' protocol holds promise for safely providing adequate pain relief to patients with acute severe pain," Dr. Chang points out.

For the study, Dr. Chang and his colleagues provided 1 milligram of intravenous (IV) hydromorphone to adult patients reporting acute, severe pain. Thirty minutes later, the patient was asked, "Do you want more pain medication?" The patient was then asked the same question at 30-minute intervals and given an additional 1 milligram IV hydromorphone each time he/she answered "yes."

The study's primary endpoint was the proportion of patients achieving satisfactory pain control, defined as declining additional pain medication on 1 or more occasions.

Of the 207 patients enrolled in the study, 114 received 1 milligram of hydromorphone (the initial dose), 78 received 2 milligrams, nine received 3 milligrams and six received 4 milligrams. No adverse events were associated with amount of hydromorphone received.

According to researchers, all but two of the patients achieved satisfactory pain control within 2 to 4 hours (the study period's duration). Almost all of the patients were satisfied with their pain treatment: 67 percent reported being very satisfied and 29 percent reported being satisfied.

"The crowded conditions in most emergency departments in the U.S. are not conducive to fully individualised pain treatment," notes Dr. Chang. "Our use of a non-numerical, simple yes/no question offers patients the ability to decide for themselves whether their pain is adequately controlled and allows them to balance pain relief against medication side effects such as nausea and drowsiness."

Source: American College of Emergency Physicians
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Chang AK, Gallagher EJ et al. (2015) Efficacy of an Acute Pain Titration Protocol Driven by Patient Response to a Simple Query: Do You Want More Pain Medication? Annals of Emergency Medicine, June 2015 DOI: 10.1016/j.annemergmed.2015.04.035

Published on : Tue, 16 Jun 2015

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healthmanagement, pain, emergency department, ER, hydromorphone, protocol A simple yes/no question could be an effective tool to help patients decide for themselves whether their pain is adequately controlled, according to researchers.

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