Comfort scores instead of pain scores as a possible tool for pain and analgesia reduction in the emergency department: A randomized controlled clinical trial

Abstract

Introduction

Frequent use of the term ’pain’ in clinical settings has been associated with the nocebo effect, potentially leading to increased pain perception and unnecessary analgesic use. This study aimed to explore the impact of cognitive reframing, employing comfort scores (CS) instead of pain scores (PS), on analgesic desire and usage in adults presenting to the emergency department (ED) with abdominal pain.

Methods

In this randomized controlled trial, ED patients with abdominal pain were assigned to either the PS group (assessing pain using a pain score) or CS group (assessing comfort using an inverted pain score). In the CS group, explicit references to ’pain’ or ’discomfort’ were avoided. Desire for and use of analgesia were assessed at triage, 1 h post-entry, and at ED discharge. Statistical analyses included the Mann-Whitney U test for CS vs. PS and the Chi-squared test for analgesia desire and patient satisfaction.

Results

Among the 496 included patients (36 % male, median age 52 (IQR 31–67) years), CS and PS groups showed similar characteristics and prehospital analgesic use. The PS group required slightly less morphine in dosage (PS: 0.05 mg/kg (0.03–0.07) vs. CS: 0.07 mg/kg (0.04–0.10), p = 0.03). CS scores were lower than PS scores, but only significant at 1 h post-entry (CS median (IQR): 5 (4–6) vs. PS 6 (4–7), p = 0.03). Baseline analgesic desire was lower in the CS group (45 % vs. 54 %, p = 0.06), with no differences in administered analgesic types. Treatment satisfaction did not differ between groups.

Conclusion

In this study using CS as opposed to PS did not affect the desire for or the use of opioids or other analgesia in adult patients with abdominal pain presenting at the ED. Although CS may be potentially useful, using it instead of PS as a tool for cognitive reframing is currently not supported in the uncontrolled clinical setting of the ED.