Impact of demographic and deprivation factors on paramedic-led pain management: a UK NHS service evaluation.

Introduction: Pre-hospital pain is prevalent and frequently undertreated. Limited UK-based research has examined the influence of demographic and deprivation factors on paramedic-led pain management. Early effective management of acute pain has been shown to improve patient satisfaction and outcomes, and evaluating the effectiveness of such an important intervention is critical given the limited formulary that paramedics have access to, combined with the diverse communities that paramedics serve. Hence, this service evaluation aimed to evaluate the overall effectiveness of paramedic-led pain management, considering the effectiveness in relation to demographic and deprivation factors in adult patients in the pre-hospital setting.

Methods: A retrospective observational service evaluation was conducted using anonymised adult (18+) clinical record data. This was collected from the North East Ambulance Service NHS Foundation Trust for the period of 1 July 2023 to 30 June 2024. The primary outcome was the achievement of the minimum clinically important difference (MCID: ≥2-point or 30% reduction) and adequate pain management (APM: ≥50% reduction) on the 11-point numeric pain scale (NRS-11). Outcomes were compared across sex, age and Index of Multiple Deprivation decile.

Results: Of 54,998 eligible cases, the MCID was achieved in 41.98% and APM in 24.76% of patients. As social deprivation increases, patients become significantly less likely to achieve the MCID or APM (MCID: ρ = 0.81, 95% CI: 0.39, 0.96, p = 0.007; APM: ρ = 0.88, 95% CI: 0.56, 0.97, p = 0.002). Male patients were marginally more likely to achieve APM than female (1.13%, 95% CI: 0.40, 1.86%, p = 0.002). Increasing age correlated strongly with both MCID (ρ = 0.90, 95% CI: 0.74, 0.96, p <0.001) and APM (ρ = 0.90, 95% CI: 0.75, 0.96, p <0.001) achievement.

Conclusion: Paramedic-led pain management is associated with a pain reduction in most cases; however, the magnitude of this reduction varies. Increased age, lower social deprivation and the male sex were associated with greater reported analgesic effectiveness. The reasoning for this is unclear. Further research to determine causality and inform practice in pre-hospital pain management are required before definitive conclusions can be drawn.