Lack of influence of patient self-report of pain intensity on administration of opioids for suspected long-bone fractures.

Abstract

UNLABELLED:

The purpose of the present study was to prospectively investigate the extent to which emergency providers base their decisions about pain management of suspected long-bone fracture on patient's self-reported pain intensity. Of 100 long-bone fracture patients presenting to 2 inner-city emergency departments, 69% received opioids as compared to 30% of 110 patients without long-bone fracture (RR = 2.3; 95% CI 1.6 to 3.1). After stratification by pain ratings on a validated self-reported numerical rating scale, fracture patients remained twice as likely to receive opioids as those without fracture (RR = 2.0; 95% CI 1.5 to 2.7). Similarly, multivariate adjustment for self-reported pain intensity had little effect on the observed association (RR = 2.1; 95% CI 1.6 to 2.8). We conclude that emergency providers do not primarily base their decisions about pain management of suspected long-bone fractures on patient self-reporting of pain intensity.

PERSPECTIVE:

This article addresses the question of the role of self-reported pain intensity rating on the treatment of suspected fractures. The findings indicate that self-reported pain is not used as the most important measure of pain as recommended by expert panels. We speculate this may contribute to oligoanalgesia in the Emergency Department.

• Authors: Polly E Bijur, Anick Bérard, David Esses, Jordan Nestor, Clyde Schechter, E John Gallagher
• Journal: The journal of pain (J Pain) Vol. 7 Issue 6 Pg. 438-44 (Jun 2006) ISSN: 1526-5900 [Print] United States
• PMID: 16750800 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Analgesics, Opioid

Topics

• Analgesia (psychology, statistics & numerical data, trends)
• Analgesics, Opioid (therapeutic use)
• Decision Making
• Emergency Service, Hospital (statistics & numerical data, trends)
• Fractures, Bone (complications)
• Humans
• Pain (drug therapy, etiology, psychology)
• Pain Measurement (methods, psychology, trends)
• Physician-Patient Relations
• Prospective Studies
• Self-Assessment