Assessment of acute pain in trauma—A retrospective prehospital evaluation

2016 ◽  
Vol 12 (5) ◽  
pp. 347 ◽  
Author(s):  
Stine Hebsgaard, MD ◽  
Anne Mannering, MD ◽  
Stine T. Zwisler, MD, PhD
Keyword(s):  
Endotracheal Intubation ◽  
Severe Pain ◽  
Rating Scale ◽  
Pain Treatment ◽  
Opioid Analgesics ◽  
Multiple Injuries ◽  
Pharmacological Intervention ◽  
Mild Pain ◽  
Trauma Population ◽  
Opioid Administration

Objective: To elucidate pain treatment with analgesics in a prehospital trauma population.Design: Retrospective database study.Setting: Prehospital data from the anesthesiologist-manned Mobile Emergency Care Unit (MECU) in Odense, Denmark, were extracted and subjected to analysis.Patients: During the period of January 1, 2013 to December 31, 2014, patients with the diagnoses “unspecified multiple injuries,” “examination and observation following traffic accident,” “examination and observation following other accident,” and “commotio cerebri” were included in the analysis.Main Outcome Measures: Evaluation of the application of the pain scale Numeric Rating Scale (NRS). Furthermore, the authors performed a characterization of the patients with mild pain and severe pain according to specific parameters such as pharmacological interventions, opioid consumption, intubation, and others.Results: Nine hundred eighty-five cases were analyzed. NRS was documented only in one case. In all, 787 patients experienced no pain or mild pain (no pain, n = 242; mild pain, n = 545) and 168 patients severe pain or worse (severe pain, n = 155; intolerable pain, n = 13). In the severe pain group, 138 were treated with opioid analgesics or S-ketamine, while no pharmacological intervention was documented in 30 cases. Eight of the 138 cases with severe pain needed endotracheal intubation, whereas nine cases in the patients with mild or no pain needed endotracheal intubation; odds ratio (OR) 4.3 (p = 0.003).Conclusions: Effect was only documented in one patient after administering opioids in a patient with trauma population, where approximately 17 percent of patients experienced severe pain. Severe pain was correlated to male gender, respiratory intervention, opioid administration, and the diagnosis unspecified multiple injuries.

Postoperative Pain and Age: A Retrospective Cohort Association Study

2021 ◽  
Author(s):  
Jacqueline F. M. van Dijk ◽  
Ruth Zaslansky ◽  
Regina L. M. van Boekel ◽  
Juanita M. Cheuk-Alam ◽  
Sara J. Baart ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Retrospective Cohort ◽  
Severe Pain ◽  
Rating Scale ◽  
Pain Treatment ◽  
The Elderly ◽  
Numeric Rating Scale ◽  
Opioid Administration ◽  
Patient Reported ◽  
Numeric Rating

Background As the population ages, the number of elderly people undergoing surgery increases. Literature on the incidence and intensity of postoperative pain in the elderly is conflicting. This study examines associations between age and pain-related patient reported outcomes and perioperative pain management in a dataset of surgical patients undergoing four common surgeries: spinal surgery, hip or knee replacement, or laparoscopic cholecystectomy. Based on the authors’ clinical experience, they hypothesize that pain scores are lower in older patients. Methods In this retrospective cohort, study data were collected between 2010 and 2018 as part of the international PAIN OUT program. Patients filled out the International Pain Outcomes Questionnaire on postoperative day 1. Results A total of 11,510 patients from 26 countries, 59% female, with a mean age of 62 yr, underwent one of the aforementioned types of surgery. Large variation was detected within each age group for worst pain, yet for each surgical procedure, mean scores decreased significantly with age (mean Numeric Rating Scale range, 6.3 to 7.3; β = –0.2 per decade; P ≤ 0.001), representing a decrease of 1.3 Numeric Rating Scale points across a lifespan. The interference of pain with activities in bed, sleep, breathing deeply or coughing, nausea, drowsiness, anxiety, helplessness, opioid administration on the ward, and wish for more pain treatment also decreases with age for two or more of the procedures. Across the procedures, patients reported being in severe pain on postoperative day one 26 to 38% of the time, and pain interfered moderately to severely with movement. Conclusions The authors’ findings indicate that postoperative pain decreases with increasing age. The change is, however, small and of questionable clinical significance. Additionally, there are still too many patients, at any age, undergoing common surgeries who suffer from moderate to severe pain, which interferes with function, supporting the need for tailoring care to the individual patient. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Participants with mild, moderate, or severe pain following total hip arthroplasty. A sub-study of the PANSAID trial on paracetamol and ibuprofen for postoperative pain treatment

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Luma Mahmoud Issa ◽  
Kasper Højgaard Thybo ◽  
Daniel Hägi-Pedersen ◽  
Jørn Wetterslev ◽  
Janus Christian Jakobsen ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Severe Pain ◽  
Pain Treatment ◽  
Opioid Analgesic ◽  
Opioid Use ◽  
Mild Pain ◽  
Total Hip ◽  
Pain Scores

AbstractObjectivesIn this sub-study of the ‘Paracetamol and Ibuprofen in Combination’ (PANSAID) trial, in which participants were randomised to one of four different non-opioids analgesic regimen consisting of paracetamol, ibuprofen, or a combination of the two after planned primary total hip arthroplasty, our aims were to investigate the distribution of participants’ pain (mild, moderate or severe), integrate opioid use and pain to a single score (Silverman Integrated Approach (SIA)-score), and identify preoperative risk factors for severe pain.MethodsWe calculated the proportions of participants with mild (VAS 0–30 mm), moderate (VAS 31–60 mm) or severe (VAS 61–100 mm) pain and the SIA-scores (a sum of rank-based percentage differences from the mean rank in pain scores and opioid use, ranging from −200 to 200%). Using logistic regression with backwards elimination, we investigated the association between severe pain and easily obtainable preoperative patient characteristics.ResultsAmong 556 participants from the modified intention-to-treat population, 33% (95% CI: 26–42) (Group Paracetamol + Ibuprofen (PCM + IBU)), 28% (95% CI: 21–37) (Group Paracetamol (PCM)), 23% (95% CI: 17–31) (Group Ibuprofen (IBU)), and 19% (95% CI: 13–27) (Group Half Strength-Paracetamol + Ibuprofen (HS-PCM + IBU)) experienced mild pain 6 h postoperatively during mobilisation. Median SIA-scores during mobilisation were: Group PCM + IBU: −48% (IQR: −112 to 31), Group PCM: 40% (IQR: −31 to 97), Group IBU: −5% (IQR: −57 to 67), and Group HS-PCM + IBU: 6% (IQR: −70 to 74) (overall difference: p=0.0001). Use of analgesics before surgery was the only covariate associated with severe pain (non-opioid: OR 0.50, 95% CI: 0.29–0.82, weak opioid 0.56, 95% CI: 0.28–1.16, reference no analgesics before surgery, p=0.02).ConclusionsOnly one third of participants using paracetamol and ibuprofen experienced mild pain after total hip arthroplasty and even fewer experienced mild pain using each drug alone as basic non-opioid analgesic treatment. We were not able, in any clinically relevant way, to predict severe postoperative pain. A more extensive postoperative pain regimen than paracetamol, ibuprofen and opioids may be needed for a large proportion of patients having total hip arthroplasty. SIA-scores integrate pain scores and opioid use for the individual patient and may add valuable information in acute pain research.

scholarly journals Pain Intensity on the First Day after Surgery

2013 ◽  
Vol 118 (4) ◽  
pp. 934-944 ◽  
Author(s):  
Hans J. Gerbershagen ◽  
Sanjay Aduckathil ◽  
Albert J. M. van Wijck ◽  
Linda M. Peelen ◽  
Cor J. Kalkman ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Surgical Procedures ◽  
Severe Pain ◽  
Rating Scale ◽  
Pain Treatment ◽  
Numeric Rating Scale ◽  
Treatment Needs ◽  
Pain Scores ◽  
Numeric Rating

Abstract Background: Severe pain after surgery remains a major problem, occurring in 20–40% of patients. Despite numerous published studies, the degree of pain following many types of surgery in everyday clinical practice is unknown. To improve postoperative pain therapy and develop procedure-specific, optimized pain-treatment protocols, types of surgery that may result in severe postoperative pain in everyday practice must first be identified. Methods: This study considered 115,775 patients from 578 surgical wards in 105 German hospitals. A total of 70,764 patients met the inclusion criteria. On the first postoperative day, patients were asked to rate their worst pain intensity since surgery (numeric rating scale, 0–10). All surgical procedures were assigned to 529 well-defined groups. When a group contained fewer than 20 patients, the data were excluded from analysis. Finally, 50,523 patients from 179 surgical groups were compared. Results: The 40 procedures with the highest pain scores (median numeric rating scale, 6–7) included 22 orthopedic/trauma procedures on the extremities. Patients reported high pain scores after many “minor” surgical procedures, including appendectomy, cholecystectomy, hemorrhoidectomy, and tonsillectomy, which ranked among the 25 procedures with highest pain intensities. A number of “major” abdominal surgeries resulted in comparatively low pain scores, often because of sufficient epidural analgesia. Conclusions: Several common minor- to medium-level surgical procedures, including some with laparoscopic approaches, resulted in unexpectedly high levels of postoperative pain. To reduce the number of patients suffering from severe pain, patients undergoing so-called minor surgery should be monitored more closely, and postsurgical pain treatment needs to comply with existing procedure-specific pain-treatment recommendations.

scholarly journals ASSOCIATIONS OF PAIN INTENSITY WITH SEDENTARY BEHAVIOR AND PHYSICAL ACTIVITY IN OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S20-S21
Author(s):  
Kushang Patel ◽  
Andrea LaCroix ◽  
Paul Crane ◽  
Rod L Walker ◽  
KatieRose Richmire ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Pain Intensity ◽  
Sedentary Behavior ◽  
Severe Pain ◽  
Rating Scale ◽  
Future Research ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Mild Pain

Abstract Exercise is recommended for several painful, age-associated conditions; however, relationships between pain intensity and objectively measured sedentary behavior and physical activity have not been investigated in older adults. Accordingly, we analyzed cross-sectional data on 936 older adults in the ACT Study who self-reported their pain intensity on a 0-10 rating scale (0=no pain; 1-3=mild pain; and 4-10=moderate/severe pain) and wore an activPAL accelerometer. A total of 181 (19.3%) reported no pain, while 564 (60.3%) and 191 (20.4%) reported mild and moderate/severe pain, respectively. Linear regression models adjusted for age and sex estimated that compared to those with no pain, participants with moderate/severe pain walked significantly fewer steps/day (b-coefficient=-778 [95%CI: -1377, -179]) and had fewer sit-to-stand transitions/day (b-coefficient=-2.9 [95%CI: -5.6, -0.1]). In contrast, there were no significant differences in these outcomes comparing no pain versus mild pain. Future research will examine effects of pain treatments (opioids) and diagnoses on accelerometer-measured outcomes.

scholarly journals Painful Recall in Elective Electrical Cardioversion with Propofol and the Need for Additional Analgesia

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
D. F. M. van Winden ◽  
A. Westra ◽  
P. J. W. Dennesen ◽  
S. H. J. Monnink ◽  
B. C. Verdouw ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Muscle Pain ◽  
Severe Pain ◽  
Rating Scale ◽  
Electrical Cardioversion ◽  
Secondary Outcome ◽  
Prospective Multicenter Study ◽  
Mild Pain ◽  
Sole Agent ◽  
Electrical Shocks

Introduction. Electrical cardioversion (ECV) is a short but painful procedure for treating cardiac dysrhythmias. There is a wide variation regarding the medication strategy to facilitate this procedure. Many different sedative techniques for ECV are described. Currently, the optimal medication strategy to prevent pain in ECV has yet to be established. The role for additional analgesic agents to prevent pain during the procedure remains controversial, and evidence is limited. Methods. We conducted a prospective multicenter study to determine the incidence of painful recall in ECV with propofol as a sole agent for sedation, in order to assess the indication for additional opioids. In all patients, sedation was induced with propofol titrated till loss of eyelash reflex and nonresponsiveness to stimuli, corresponding to Ramsay Sedation Score level 5-6. ECV was performed with extracardiac biphasic electrical shocks. The primary outcome was painful recall of the procedure, defined as numeric pain rating scale (NRS) ≥ 1. NRS ≥ 4 is considered inadequately treated pain. Secondary outcome parameters were pain at the side of the defipads and muscle pain after ECV. Results. A total of 232 patients were enrolled in this study. Six patients were excluded due to missing data or violation of study protocol. Three patients reported recall of the procedure, and one patient (0.4%) reported recall of severe pain during the procedure with NRS 7. Two patients (0.9%) reported recall of mild pain with NRS 1–3. Complete amnesia was observed in 223 patients (98.7%), with NRS 0. The mean of the total dose of propofol was 1.1 mg/kg. Fifteen patients (6.6%) experienced pain at the side of the defipads, and six patients (2.7%) complained of muscle pain after the procedure. Conclusions. In this prospective multicenter study, propofol as a sole agent provided good conditions for ECV with a low incidence of recall. Effective sedation and complete amnesia was achieved in 98.7% of the patients, 0.4% of patients reported recall of severe pain during the procedure, and 0.9% of patients experienced mild pain during the ECV.

scholarly journals MP15: Predictors of emergency department opioid use and variability of prescribing practices in a large multicenter Canadian cohort

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S47-S48
Author(s):  
T. Lau ◽  
J. Hayward ◽  
G. Innes
Keyword(s):  
Emergency Department ◽  
Pain Score ◽  
Rating Scale ◽  
Pain Treatment ◽  
Future Research ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Opioid Administration ◽  
Unit Increase

Introduction: Emergency department (ED) opioid prescribing has been linked to long-term use and dependence. Anecdotally, significant opioid practice variability exists between physicians and institutions, but this is poorly defined. Our objective was to collate and analyze multicenter data looking at predictors of ED opioid use and to identify potential areas for opioid stewardship. Methods: We linked administrative and computerized physician order entry (CPOE) data from all four ED's within our municipality over a one-year period. Eligible patients included those with a Canadian Triage and Acuity Scale (CTAS) pain complaint or an arrival numeric rating scale (NRS) pain score of greater than 3/10. Patients with missing demographic or chief complaint data were excluded. Multiple imputation was used for missing NRS pain scores. We performed descriptive analyses of opioid-treated and non-treated patients, followed by a multivariable logistic regression to identify predictors of ED opioid administration. Results: A total of 129,547 patients were studied. The mean age was 47.4 years and 55.4% were female. The median pain score was 6.6 in the no-opioid group and 8 in the opioid group. The most common pain categories were abdominal pain (23%), trauma (18.2%) and chest pain (15.3%). Overall, opioids were prescribed to 34% of patients. The most common CTAS score was CTAS 3 (44%), CTAS 1-2 42%) and CTAS 4-5 (13.9%). Multivariable predictors of opioid-use included the need for admission (adjusted OR 6.57; CI = 6.34-6.79), NRS pain score (aOR 1.24 per unit increase, CI 1.23-1.25), higher numerical CTAS score (aOR 0.89 per unit increase, CI 0.87-0.91), and chief complaints of back (aOR 7.69, CI 7.1-8.1), abdominal (aOR 5.9, CI 5.6-6.2), and flank pain (OR 3.8, CI 3.5-4). Oral opioids were prescribed in 39.8% of back pain presentations and 18.5% received IV opioids. Increasing age was a predictor but sex was not. There were significant institutional differences in opioid prescribing rates, with Hospital B being the least likely to prescribe opioids (aOR 0.82, CI 0.80-0.85) followed by Hospital C (aOR 0.83, CI 0.79-0.86) compared to the reference standard of Hospital A. Hospital D was most likely to prescribe opioids (aOR 1.32, CI 1.27-1.37). Conclusion: Predictors of ED opioid use were characterized using multicenter administrative data. Future research should seek to describe the physician- and site-level factors driving regional variation in opioid-based pain treatment.

scholarly journals Steroid Antibiotic Pack Versus 10% Ichthammol Glycerol Pack in Management of Acute Otitis Externa: A Comparative Study

2021 ◽  
Vol 12 (1) ◽  
pp. 192-198
Author(s):  
Akshaya Thrinetrapriya N ◽  
Nandhini R ◽  
Shoba K
Keyword(s):  
Severe Pain ◽  
Otitis Externa ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Randomised Clinical Trial ◽  
Rapid Onset ◽  
Moderate Pain ◽  
Predisposing Factor ◽  
Mild Pain ◽  
Institutional Review

Acute otitis externa is a common clinical condition that presents with rapid onset of otalgia, fullness, otorrhea and canal oedema. Moisture in-ear canal appears to be an important predisposing factor. The most common etiological agents include Pseudomonas aeruginosa and Staphylococcus aureus. Management includes control of otalgia and elimination of infection from the ear. Precipitating factors should be avoided. The main objective of this study is to compare the efficacy of 10% ichthammol glycerol ear pack with steroid antibiotic ear pack in the treatment of acute otitis externa. Institutional Review Board (IRB) clearance was obtained, and a prospective randomised clinical trial was conducted in the ENT outpatient department of Saveetha Medical College & Hospital, Thandalam, from January 2020 to March 2020. Patients were explained about the study in detail, and consent was obtained. The patients were randomised, and 10% ichthammol glycerol pack and steroid antibiotic pack were used in alternate turns for aural packing. Pain rating was done using Numerical rating scale (NRS) before and 48 hours post-treatment and also in each subsequent hospital visit till complete subsidence of symptoms. Among the 85 patients included in the study, 42 (49.4%) were males, and 43 (50.6%) were females. Most of them belonged to the age group 31-40 years (41.2%). Tragal tenderness and external auditory canal oedema were the most common ear findings noted. In the patients treated with steroid antibiotic pack, only 2.3% of the patients had severe pain, whereas 14% had moderate pain and 83.7% had only mild pain. Whereas among those treated with 10% ichthammol glycerol pack, 9.5% of the patients had severe pain, whereas 35.7% had moderate pain and 54.8% had mild pain. On analysis, the results were statistically significant, and there was considerable pain relief with steroid antibiotic pack. Therefore, our study showed that steroid antibiotic pack is more effective in relieving the symptoms, thereby reducing the number of hospital visits when compared to 10% ichthammol glycerol pack.

Sending out Biased Signals: an Appropriate Proposition for Pain?

2019 ◽  
Vol 32 (2) ◽  
pp. 108-110 ◽  
Author(s):  
E. Besserer-Offroy ◽  
P. Sarret
Keyword(s):  
Side Effects ◽  
Acute Pain ◽  
Gold Standard ◽  
Pain Treatment ◽  
Opioid Analgesics ◽  
Mu Opioid Receptor ◽  
Clinical Development ◽  
Mu Opioid ◽  
Development Stages ◽  
The Past

In the past few years, several biased ligands acting at the mu-opioid receptor were reported in the literature. These agonists are aimed at reducing pain while having fewer side effects than morphine, the gold standard of opioid analgesics. In this mini-review, we describe and discuss the recent advances in mu-biased ligands actually in preclinical and clinical development stages, including the latest U.S. Food and Drug Administration review of oliceridine, a biased mu-agonist for moderate to severe acute pain treatment developed by the company Trevena.

POSTOPERATIVE ANALGESIA IN ONCOLOGIC HOSPITAL: CURRENT STATUS AND PROSPECTS

2017 ◽  
Vol 63 (1) ◽  
pp. 95-98
Author(s):  
Aleksandr Potapov ◽  
Anna Boyarkina ◽  
Igor Kostyuk ◽  
Sergey Ivanov ◽  
Vsevolod Galkin
Keyword(s):  
Postoperative Analgesia ◽  
Severe Pain ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Current Status ◽  
Regional Analgesia ◽  
Surgical Pain ◽  
Oncological Patients ◽  
Maximum Pain ◽  
Chronic Post Surgical Pain

Observational study of the postoperative analgesia efficacy with multimodal approach (acetaminophen, NSAIDs, opioids, regional analgesia) in 100 oncological patients has been conducted. On the first day after the surgery maximum pain level was 5 (3-7) points of numeric rating scale (NRS), 38% of patients experienced severe pain (NRS>6 points). After laparo-, thoracoscopic, videoassisted interventions and in cases of epidural analgesia NRS levels were 3 (1-6) and 3 (2-5) points respectively. After the surgeries with high risk of chronic post-surgical pain (thoracic, mammary gland interventions, Phan-nenstiel incision) NRS level was 6 (1-7) points. Patients in this group more often experienced severe pain than in the rest group - 56,7% vs. 32,5% (P.=0.037). Suggesting results of this study and data of current literature the perspectives of further improvement of postoperative analgesia in oncology have been formulated.

scholarly journals Cut-off points between pain intensities of the postoperative pain using receiver operating characteristic (ROC) curves

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sooyoung Cho ◽  
Youn Jin Kim ◽  
Minjin Lee ◽  
Jae Hee Woo ◽  
Hyun Jung Lee
Keyword(s):  
Postoperative Pain ◽  
Receiver Operating Characteristic ◽  
Severe Pain ◽  
Operating Characteristic ◽  
Rating Scale ◽  
Intraclass Correlation ◽  
Pain Medication ◽  
Patient Specific ◽  
Moderate Pain ◽  
Receiver Operating

Abstract Background Pain assessment and management are important in postoperative circumstances as overdosing of opioids can induce respiratory depression and critical consequences. We aimed this study to check the reliability of commonly used pain scales in a postoperative setting among Korean adults. We also intended to determine cut-off points of pain scores between mild and moderate pain and between moderate and severe pain by which can help to decide to use pain medication. Methods A total of 180 adult patients undergoing elective non-cardiac surgery were included. Postoperative pain intensity was rated with a visual analog scale (VAS), numeric rating scale (NRS), faces pain scale revised (FPS-R), and verbal rating scale (VRS). The VRS rated pain according to four grades: none, mild, moderate, and severe. Pain assessments were performed twice: when the patients were alert enough to communicate after arrival at the postoperative care unit (PACU) and 30 min after arrival at the PACU. The levels of agreement among the scores were evaluated using intraclass correlation coefficients (ICCs). The cut-off points were determined by receiver operating characteristic curves. Results The ICCs among the VAS, NRS, and FPS-R were consistently high (0.839–0.945). The pain categories were as follow: mild ≦ 5.3 / moderate 5.4 ~ 7.1 /severe ≧ 7.2 in VAS, mild ≦ 5 / moderate 6 ~ 7 / severe ≧ 8 in NRS, mild ≦ 4 / moderate 6 / severe 8 and 10 in FPS-R. The cut-off points for analgesics request were VAS ≧ 5.5, NRS ≧ 6, FPS-R ≧ 6, and VRS ≧ 2 (moderate or severe pain). Conclusions During the immediate postoperative period, VAS, NRS, and FPS-R were well correlated. The boundary between mild and moderate pain was around five on 10-point scales, and it corresponded to the cut-off point of analgesic request. Healthcare providers should consider VRS and other patient-specific signs to avoid undertreatment of pain or overdosing of pain medication.

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