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How to Manage Pain in the ER: Ask the Patient

Researchers create simple yes/no protocol

Simply asking the question, “Do you want more pain medication?” resulted in satisfactory pain control in 99% of emergency department (ED) patients participating in a study of a new evidence-based protocol to treat acute, severe pain in the ED setting.

The study was published online June 11 in the Annals of Emergency Medicine.

“The crowded conditions in most emergency departments in the U.S. are not conducive to fully individualized pain treatment,” said lead author Andrew Chang, MD, MS, of the Department of Emergency Medicine at Montefiore Medical Center in Bronx, New York. “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.”

Researchers provided 1 mg of intravenous (IV) hydromorphone to adult patients who reported acute, severe pain. Thirty minutes later, the patients were asked, “Do you want more pain medication?” The patients were then asked the same question at 30-minute intervals and were given an additional 1 mg of IV hydromorphone each time they answered “yes.”

Of the 207 patients enrolled in the study, 114 (55%) received 1 mg of hydromorphone (the initial dose); 78 (38%) received 2 mg; nine (4%) received 3 mg, and six (3%) received 4 mg. All but two of the patients achieved satisfactory pain control within 2 to 4 hours (the duration of the study). Almost all of the patients were satisfied with their pain treatment: 67% reported being very satisfied, and 29% reported being satisfied.

“Pain perception is highly subjective and not necessarily correlated to pain scores,” Chang said. “Our pain protocol is a departure from the more traditional ways of assessing pain relief, which typically use the visual analog scale or the numerical rating scale. Instead, 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. This likely explains the wide range of pain scores (as much as 0 to ten) for patients who did not ask for pain medication."

Sources: EurekAlert; June 12, 2015; and AEM; June 11, 2015.


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