Burden of pain in Emergency medicine

Pain documentation in Australian emergency departments (EDs) is neither common nor consistent, resulting in under-treatment of acute pain, known as oligoanalgesia. This is due to the usually low prioritisation of pain measurement and management, even though it impacts patients in their ED experiences and treatment of underlying conditions.
Our first objective was to characterise the trend and impact of current pain scoring trends alongside patterns of analgesic administration and durations of stay. From this, we hoped to demonstrate the value of introducing a method that depicts pain score trends over extended periods of time, incorporating both severity and duration, which could universalise the quantification of acute pain in EDs. Specifically, we proposed that a Burden of Pain (BOP), represented by the area under the curve (AUC), could enable more informative guidelines for more efficient and appropriate management of patients’ pain.
We conducted a study consisting of a retrospective and a prospective portion. The first part of the study involved analysing the administrative data on EMR FirstNET® of all adult patients who presented with acute pain at designated 6-hour periods over 5 days of the week (22nd August 2018 – 26th August 2018). The 2nd part of the study involved recruiting a convenience sample of adult patients in pain upon which to conduct serial pain scoring at 0.5-hour intervals over the same designated 6-hour periods over the same 5 days of another week (12th September 2018 – 17th September 2018).
There were 102 patients identified in the retrospective, control group and 41 in the prospective, test group. The median number of pain scores obtained in the control group was 0 and only 19 patients (18.63%) represented the median time to first pain score of 30 minutes. Analgesic administration patterns were found to be incomplete in many medication records, but what was available showed TTAs that exceed nationally recommended timeframes. Higher pain scoring frequencies in our test group, with a median of 7 pain scores obtained per patient, enabled our novel metric of generating pain score curves to display strong potential in being a universal metric of measuring and representing pain trajectories