Understanding the need for and use of analgesics in the emergency department

Background

Assessing factors related to patients and clinicians, particularly nurses, along with pain scores and their association with opioid administration is important before introducing non-pharmacological innovations in the emergency department.

Methods

A prospective cross-sectional study was conducted using multivariable logistic regression analysis. The primary outcome was the association of opioid administration with patient’s age, sex, pain acceptability, pain location, pre-hospital use of analgesics, baseline numeric rating scale (NRS) pain score at rest, desire for analgesics, and the nurses’ perception of the reported pain score. Secondary outcomes included NRS anxiety, analgesics use and prescription, patient satisfaction, and the patient’s definition of pain acceptability. Cut-off NRS pain scores for pain acceptability and desire for analgesics were calculated. Patient definitions of pain acceptability were determined using thematic analysis.

Results

Data from 236 patients were analyzed. Factors associated with administering opioids included nurse-perceived adequate pain score, higher baseline NRS pain scores, pre-hospital opioid use, and unacceptable pain. The cut-off NRS pain scores were 7 for pain acceptability and 6 for the desire for analgesics. Patients related pain acceptability to pain characteristics and situational context.

Conclusions

Nurse perception of the patient-reported pain score and pain acceptability are important determinants for administering analgesics. The insufficient discriminative power of a cut-off NRS pain score highlights that pain management should go beyond pain scores alone. These findings could enhance selecting patients with acute pain who may benefit from non-pharmacological interventions in the emergency department.