By: 6 July 2015
How to manage pain in the ER: Ask the patient

How to manage pain in the ER: Ask the patient

Simply asking the question, “Do you want more pain medication?” resulted in satisfactory pain control in 99 per cent of patients participating in a US study of a new evidence-based protocol to treat acute, severe pain in emergency department patients.
“The crowded conditions in most emergency departments in the US are not conducive to fully individualised pain treatment,” said author Andrew Chang, of the department of emergency medicine at Montefiore Medical Center in 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 1mg of intravenous (IV) hydromorphone to adult patients reporting acute, severe pain. Thirty minutes later, each patient was asked: “Do you want more pain medication?” The same question was asked at 30-minute intervals and the patient given an additional 1mg of IV hydromorphone each time he/she answered yes.
Of the 207 patients enrolled in the study, published online in Annals of Emergency Medicine, 114 received 1mg of hydromorphone (the initial dose); 78 received 2mg, nine received 3mg and six received 4mg. 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 per cent reported being very satisfied and 29 per cent reported being satisfied.
“Pain perception is highly subjective and not necessarily correlated to pain scores,” said Chang. “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. 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.”
Source: Science Daily

Chang, A.K., Bijur, P.E., Holden, L. & Gallagher, E.J. (2015) Efficacy of an acute pain titration protocol driven by patient response to a simple query: ‘Do you want more pain medication?’ Ann. Emerg. Med. doi: 10.1016/j.annemergmed.2015.04.035