Ability of pain scoring scales to differentiate between patients desiring analgesia and those who do not in the emergency department

Subjective risk factors of severe pain at discharge from the emergency department

OBJECTIVE

To examine the risk factors for severe pain upon discharge from the emergency department, assuming appropriate pharmacological treatment of pain, in order to improve pain relief in emergency departments and reduce the risk of potential chronic pain.

METHODS

An analytic study was conducted utilizing data from a multicenter randomized controlled trial to evaluate patients' experiences upon admission and discharge from the emergency department (ED). Severe pain was defined by a score of six on a numerical rating scale of zero to ten. Stress and negative emotions (including anger, fear, sadness, and regret) were evaluated using numerical rating scales, respectively ranging from 0 to 10 and 1 to 5. The risk factors of severe pain at discharge (SPD) from ED were calculated using logistic regression considering patient characteristics evaluated at their admission to the ED.

RESULTS

From the 1240 patients analyzed, 22.2% had SPD from the ED. Each increase of one point in the intensity of acute pain and anger was significantly associated with a higher risk of SPD from ED. In addition, woman, negative self-perceived health, and age under 65 years, are other significant factors associated with SPD from the ED.

DISCUSSION

In addition to acute pain on admission, this study highlights new factors to consider when managing pain in emergency care, such as anger, and self-perceived health. Addressing these aspects can help reduce the likelihood of developing SPD from the ED, which in turn could potentially lead to the onset of chronic pain in future.

CLINICAL TRIAL REGISTRY

SOFTER IV Project clinical identification number: NCT04916678.

Defining the need for analgesia in the emergency department: protocol for an international Delphi process

INTRODUCTION

The high prevalence of pain in the emergency department (ED) highlights the importance of accurate assessments to provide effective interventions. However, common pain scales such as the Numerical Pain Rating Scale have shown limitations in assessing analgesic requirements and adequacy. The ideal outcome for evaluating a pain scale predicting analgesic requirements would be the 'need for analgesia', for which there is no universally accepted definition. Accordingly, the primary aim of this study is to define the 'need for analgesia' using an interdisciplinary approach. The secondary aim is to define the 'adequacy of analgesia'.

METHODS AND ANALYSIS

A two-stage modified Delphi process will be conducted by a core study group chosen for its expertise in ED pain management. A larger expert panel, identified through a comprehensive search in Scopus and CINAHL databases, will be invited to participate in the study and will be supplemented by patients recruited via international patient organisations or snowballing. In stage 1, the expert panel will complete a written survey to collect potential clinical variables for defining the 'need for analgesia' and 'adequacy of analgesia'. The core study group will elaborate on these variables. In stage 2, the same participants will use a five-point Likert scale to achieve consensus defined as ≥80% of combined agreement on the proposed variables, over a maximum of three rounds. The same process will be used to define the 'adequacy of analgesia'.

ETHICS AND DISSEMINATION

The Ethics Committee of Northwestern and Central Switzerland exempted the project from committee approval under the Human Research Act. Written consent will be obtained from all participants. Results will be disseminated through publication in peer-reviewed journals and conferences.

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

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.