Pain Management

[Pubmed 1]

Severe pain is a common presenting symptom for emergency patients. One major challenge in the management of severe pain is the objective measurement of pain. Due to the subjective nature of pain, it can be very difficult for clinicians to quantify pain intensity and measure the qualitative features of the pain experience. A number of measurement tools have been validated in the acute care setting, with some appropriate for use in the prehospital setting. This paper reviews the characteristics required of a prehospital acute pain measure and appraises the relative utility of a number of currently used pain measures. At present, the verbal numerical rating scale appears the most appropriate pain measure to administer in the prehospital setting for adult patients as it is practical and valid. Either the Oucher scale or the faces pain scale is suitable for prehospital care providers to assess pain in children.
[Pubmed 2]
OBJECTIVE: The aim of this study was to establish the impact of patient sex on the provision of analgesia by paramedics for patients reporting pain in the prehospital setting. METHODS: This retrospective cohort study of paramedic patient care records included all adult patients with a Glasgow Coma Score higher than 12 transported to hospital by ambulance in a major metropolitan area over a 7-day period in 2005. Data collected included demographics, patient report of pain and its type and severity, provision of analgesia by paramedics, and type of analgesia provided. The outcomes of interest were sex differences in the provision of analgesia. Data analysis was by descriptive statistics, chi2 test, and logistic regression. RESULTS: Of the 3357 patients transported in the study period, 1766 (53%) reported pain; this forms the study sample. Fifty-two percent were female, median age was 61 years, and median initial pain score (on a 0-10 verbal numeric rating scale) was 6. Forty-five percent of patients reporting pain did not receive analgesia (791/1766) (95% confidence interval [CI], 43%-47%), with no significant difference between sexes (P = .93). There were, however, significant sex differences in the type of analgesia administered, with males more likely to receive morphine (17%; 95% CI, 15%-20%) than females (13%; 95% CI, 11%-15%) (P = .01). The difference remains significant when controlled for type of pain, age, and pain severity (odds ratio, 0.61, 95% CI, 0.44-0.84). CONCLUSION: Sex is not associated with the rate of paramedic-initiated analgesia, but is associated with differences in the type of analgesia administered.
The first study tells us to use the number scale, "rate your pain from one to ten, ten being the worst". If we use this scale we have to believe our patients. Its not your emergency, remember? These patients may only complain of pain, and that may be the one treatment you should provide for them. Ice packs are a form of pain management, so often forgotten. Take their pain seriously, and you won't lose their respect. Treat them like they are over-exaggerating, and you won't deserve their respect. Think of the last time you were in serious pain. It may be difficult to convey how it feels, or how much it hurts. A back spasm is an awfully weird feeling, like a tightening that can restrict breathing. Pain management is indicated, and should be initiated in the prehospital setting.

The second study is just some interesting information on how we treat different genders in pain. This was touched on in this month's JEMS. Men get the Morphine.


akroeze said...

That's kind of funny, I get up this morning to make a post on my own blog on pain management to find that you've already done it!

I was a bit annoyed yesterday in regards to pain management. I had a female who had a flash gasoline fire cause 1st and 2nd degree burns to the calves of both legs from ankle to knee. I maxed her out with 100mcg of Fentanyl which was 2mcg/kg for her... the end of my pain protocol. I called in for permission to give more and the physician only authorized 50mcg once when I still had 15 minutes of transport to go.

When the first 100mcg doesn't touch the pain at all, what makes one think that another 50 is going to do anything significant?

It annoyed me that I had the medication available to continue to try to control her pain but I wasn't allowed to do it.

akroeze said...

I guess I didn't really comment on your specific post.

The one thing that jumped out at me about the second study (bearing in mind that I can only see the abstract) is that they comment that males are more likely to receive morphine but don't list what the other pain control methods were. Is it that males get morphine and females get fentanyl for example? It doesn't say.

Adam Thompson, EMT-P said...

The other option was inhaled analgesia. Women got the gas while men got the MS.

akroeze said...

Ok, so the question is were medics OVER treating the men or UNDER treating the women?