The Effect of Patient-Controlled Oral Analgesia for Acute Abdominal Pain after Discharge

BackgroundDuring hospitalization, patients who were admitted with acute abdominal pain must be prepared to care for themselves at home after discharge to continue established treatment, promote recovery, and avoid readmission.AimsOur aim was to investigate the quality of pain management after discharge, when patient-controlled oral analgesia was compared with standard care for patients admitted to hospital with acute abdominal pain. The primary outcome measures were pain intensity and patient perception of care. The secondary outcome measures were pain interference with activity, affective experiences, side effects, and use of analgesics.DesignA questionnaire study measuring the effect of an intervention on patient-controlled oral analgesics.SettingsAn emergency department and a surgical department in Denmark.ParticipantsPatients admitted to hospital with acute abdominal pain.MethodsA pre- and postintervention study was conducted in an emergency department and a surgical department with three subunits. Data were collected using a Danish modified Revised American Pain Society Patient Outcome Questionnaire with five subscales (scale 0-10) completed in weeks 1 and 4 after discharge.ResultsIn total, 117 patients were included. The median scores at week 1 and week 4 in the control and intervention groups were, respectively, 2/1 and 1/0 on the pain subscale (p = .11/.16), 3/0 and 3/0 on the activity subscale (p = .19/.80), 1/0 and 0/0 on the emotional subscale (p = .02/.72), 1/0 and 1/0 on the side effect subscale (p = .95/.99), and 8/5 and 7/7 on the patient perception subscale (p = .35/.49). There was no significant difference in the use of analgesics at week 1.ConclusionsPatient-controlled oral analgesia during the hospital stay did not improve the quality of pain management after discharge.     

Patient-controlled oral analgesia for acute abdominal pain: A before-and-after intervention study on pain intensity and use of analgesics

AimTo compare the use of patient-controlled oral analgesia with nurse-controlled analgesia for patients admitted to hospital with acute abdominal pain. The primary outcome measure was pain intensity. The secondary outcome measures were the use of analgesics and antiemetics.BackgroundInadequate pain management of patients with acute abdominal pain can occur during hospital admission. Unrelieved acute pain can result in chronic pain, stroke, bleeding and myocardial ischemia.MethodsA before-and-after intervention study was conducted in an emergency department and a surgical department with three subunits. Data were collected from medical charts and analyzed using chi-squared and Kruskal–Wallis tests.ResultsA total of 170 patients were included. The median pain intensity score, using the numeric ranking scale, was 2.5 and 2 on Day 2 (p = 0.10), 2 and 2 on Day 3 (p = 0,40), 2.5 and 0 on Day 4 (p = 0.10), 2 and 0 on Day 5 (p = 0.045) in the control and intervention group, respectively. The percentage of patients receiving analgesics was 93 and 86 on Day 2 (p = 0.20), 91 and 75 on Day 3 (p = 0.02), 89 and 67 on Day 4 (p = 0.009) and 80 and 63 on Day 5 (p = 0.39). The use of antiemetics was similar in the two groups.ConclusionPatient-controlled oral analgesia significantly reduced the numerical ranking pain scale score on Day 5 and the consumption of analgesics on Days 3 and 4 after hospital admission. Patient-controlled oral analgesia is feasible as pain management for patients, but only with minor impact on experienced pain intensity and use of analgesics.     

The Impact of Guided Imagery on Pain and Anxiety in Hospitalized Adults

BackgroundThe use and impact of guided imagery in the acute care setting is limited.AimsThe purpose of this quality improvement project was to evaluate the feasibility of a guided imagery intervention to change pain scores, anxiety scores, and opioid analgesia usage among hospitalized adults in an acute care setting.DesignQuality improvement project using three measurements (baseline, 24 hours, and 48 hours).SettingsAcute care hospital.Participants/SubjectsAdult inpatients referred to an APRN-led pain management service.MethodsThe intervention was the use of a 30-minute guided imagery recording delivered via MP3 player which patients used twice daily.ResultsLimited changes were seen in pain scores, with no statistically significant results (p = .449). Statistically significant reductions were found in both anxiety scores (p < .001) and opioid analgesia usage (p = .043).ConclusionsFindings from this quality improvement project support the impact of guided imagery on anxiety and opioid analgesia use. Changes in pain scores were not demonstrated in this project. Additional research with a rigorous design is needed to determine cause and effect conclusions.Clinical ImplicationsThe use of guided imagery as an adjunctive intervention for pain control may engage and empower the patient in self-care activities, which may have an impact on how care is perceived. Guided imagery is a low-cost, easily implemented approach that can be incorporated into patient care to reduce anxiety and, potentially, opioid analgesia use.     

The effect of supportive emergency department nursing care on pain reduction of patients with Red Sea marine wildlife injuries

IntroductionThe emergency department at Yoseftal hospital in Eilat is on the shore of the Red Sea, and it is visited by patients with marine wildlife injuries. The purpose of this study was to examine the effects of supportive nursing care on the pain level of patients with Red Sea marine wildlife injuries.MethodA prospective quantitative study including 102 patients admitted to the emergency department. The study included a study group (N = 50) and a control group (N = 52). Both groups rated their pain level on the VAS before and after receiving treatment. The control group received the usual treatment, and the study group received the usual nursing treatment along with structured patient guidance and support.ResultsThere was a significant difference in the level of pain after the intervention between the control and the study group. In the study group, the level of pain was significantly reduced compared with the control group (p < 0.001).DiscussionNursing training and patient guidance contributed to increasing cooperation with patients and pain reduction. Therefore, training interventions should be structured and assimilated as an integral part of nursing practice.     

The effect of the Alexander Technique on pain intensity in patients with chronic low back pain: A randomized controlled trial

ObjectiveThe present study was performed to determine the effect of the Alexander Technique on the intensity of pain in patients with chronic low back pain (LBP).MethodsThis study is a clinical trial that was performed on 80 patients with chronic LBP in Kashan, Iran. Participants were randomly assigned in control and intervention groups. To assess the participants’ LBP, a visual analog scale of pain (VAS-Pain) was completed by both groups. In the intervention group, in addition to routine care for LBP patients, the Alexander Technique was performed in three 60-min sessions per week for 12 weeks. The control group participants received routine care for LBP patients. The two groups completed the VAS-Pain scale immediately after and one month after the intervention.ResultsThe results showed that there was no statistically significant difference between the two groups in terms of demographic characteristics and mean pain intensity score before the intervention (p > 0.05). Immediately after and then one month after the intervention, there was statistically significant differences between the two groups regarding the mean scores of pain (p < 0.05). The results of repeated measures ANOVA showed that, in the intervention group, the mean score of pain had decreased over time (p < 0.05).ConclusionThe results of the present study showed that the Alexander Technique was effective in reducing the intensity of pain among the participants. We recommend the Alexander Technique as a useful and effective intervention for reducing chronic LBP.     

Effect of Transcutaneous Electrical Nerve Stimulation on Postoperative Pain and Patient Satisfaction

Background and AimsThis study was conducted to investigate the effect of transcutaneous electrical nerve stimulation on postoperative pain, changes in patients’ vital signs, and patient satisfaction after inguinal herniorrhaphy.DesignThis study used a randomized controlled design.SettingA state hospital in the west of Turkey.Participants/SubjectsThe study was conducted on 52 patients who had inguinal herniorrhaphy between January and July 2015.MethodsPatients were randomly divided into two groups (intervention and control). Intervention group patients received transcutaneous electrical nerve stimulation postoperatively five times for 30 minutes each. Electrodes in control group patients were placed, but the device was not started. At each transcutaneous electrical nerve stimulation session, the patients’ vital signs and pain severity were recorded. A satisfaction scale was administered before discharge to assess patient satisfaction with nursing care.ResultsPain scores of patients in the intervention group were lower than those in the control group (p < .05). No differences were found in pre–and post–transcutaneous electrical nerve stimulation in the vital signs. Satisfaction scores were higher in the intervention group than control group (p < .05).ConclusionsAfter inguinal herniorrhaphy, transcutaneous electrical nerve stimulation reduced postoperative pain without a negative impact on vital signs and increased patient satisfaction with nursing care.     

Pain Manifestations of COVID-19 and Their Association With Mortality: A Multicenter Prospective Observational Study

ObjectivesTo determine the prevalence and breakdown of pain symptoms among patients with coronavirus disease 2019 (COVID-19) infection admitted for nonpain symptoms and the association between the presence of pain and intensive care unit (ICU) admission and death.Patients and MethodsIn this multicenter prospective study, data on the intensity and type of pain were collected on 169 patients with active severe acute respiratory syndrome coronavirus 2 infection at 2 teaching hospitals in the United States and Korea and on 8 patients with acute pain at another large teaching hospital between February 1, 2020, and June 15, 2020.ResultsSixty-five of 169 patients (38.5%) reported an active pain condition. Among the 73 patients with pain, the most common pain symptoms were headache (n=22; 30.1%), chest pain (n=17; 23.3%), spinal pain (n=18; 24.7%), myalgia (n=13; 17.8%), abdominal or pelvic pain (n=13; 17.8%), arthralgia (n=11; 15.1%), and generalized pain (n=9; 12.3%). Those reporting headache as their main symptom were less likely to require ICU admission (P=.003). Acetaminophen or nonsteroidal anti-inflammatory drugs were prescribed to 80.8% (n=59), opioids to 17.8% (n=13), adjuvants to 8.2% (n=6), and ketamine to 5.5% (n=4) of patients with pain. When age 65 years and older and sex were controlled for in multivariable analysis, the absence of pain was associated with ICU admission (odds ratio, 2.92; 95% CI, 1.42 to 6.28; P=.004) and death (odds ratio, 3.49; 95% CI, 1.40 to 9.76; P=.01).ConclusionAcute pain is common during active COVID-19 infection with the most common manifestations being headache, chest pain and spine pain. Individuals without pain were more likely to require intensive care and expire than those with pain. Reasons why pain may be associated with reduced mortality include that an intense systemic stimulus (eg, respiratory distress) might distract pain perception or that the catecholamine surge associated with severe respiratory distress might attenuate nociceptive signaling.     

The Effectiveness of an Evidence-Based Pain Management Program on Pain Intensity and Chest Rehabilitation Improvement Among Chest Trauma Patients in a Thai Hospital

BackgroundPain after thoracic injury has further profound impacts on patients resulting in increased length of hospital stay and hospital care cost, and decreased quality of life. Utilization of the cutting-edge evidence on pain management that fits with the individual care context is therefore important.AimTo examine the effects of an evidenced-based pain management program on the worst pain intensity and lung vital capacity among acutely ill hospitalized chest trauma patients.DesignA two-group repeated measures design.Settingstrauma unit, a university hospital in southern Thailand.Participants/Subjects42 chest trauma patients.MethodsThe study population included 42 chest trauma patients admitted to the trauma unit. Twenty-one eligible chest trauma patients were consecutively assigned into intervention and control groups. The impacts of the intervention on the level of the worst pain intensity and lung vital capacity were measured before implementation of the program and throughout the first 5 days of admission.ResultsThe study found a significant reduction in the worst pain intensity and an increase in the lung vital capacity among chest trauma patients in the intervention group compared with the control group (p < .05).ConclusionsUse of a pain management program can be an effective, inexpensive, and low-risk intervention for the improvement of pain management and chest rehabilitation among chest trauma patients.     

Inpatients Admitted with a Chief Complaint of Pain Have Lower In-Hospital Mortality: A Single-Center Study of 645,998 Inpatients

BackgroundThe relationship between pain and mortality risk has not been well established.AimsThis study aimed to assess the possible association between a chief complaint of pain and in-hospital mortality.DesignRetrospective cohort study using 11-year hospital administrative data.SettingSouthwest Hospital of Third Military Medical University (Chongqing, China).ParticipantsA total of 645,998 adult inpatients admitted without department limitation between January 1, 2003, and December 31, 2013.MethodsInformation on the chief complaint at admission was obtained, and the main outcome measure was in-hospital mortality.ResultsThe crude overall in-hospital mortality rate for patients admitted with chief complaint of pain was 958 (3.9%), which was significantly lower than that of patients without pain (1,970, 4.9%). The risk of hospital death for inpatients admitted with pain was 21% lower compared to inpatients admitted without pain (p < .001). Female patients with a chief complaint of pain had a lower risk of in-hospital mortality (p < .001) compared with male patients (p < .001). When stratified by location of pain, patients with chest pain had a significantly higher risk of in-hospital mortality compared with those without complaint of pain (p < .001), whereas for patients with a chief complaint of waist, abdominal, limb, or joint pain, the risk of hospital death was lower compared with cases without pain.ConclusionsThe present study suggested that inpatients admitted with a chief complaint of pain might have a significantly lower risk of in-hospital mortality compared with those admitted without a chief complaint of pain.     

The effect of using an abdominal binder on postoperative gastrointestinal function,mobilization, pulmonary function,and pain in patients undergoing major abdominal surgery: A randomized controlled trial

BackgroundEvidence on the effectiveness of using a binder following abdominal surgery and its effect on gastrointestinal function, mobilization, pulmonary function, and pain is currently unclear.ObjectiveThe purpose of this study is to determine the effect of abdominal binder usage on gastrointestinal function, mobilization, pulmonary function, and postoperative pain in patients undergoing major abdominal surgery.DesignThis research was conducted as a randomized controlled trial.SettingsThe study was conducted at the Department of General Surgery at a military education and research hospital in Ankara, Turkey, between September 2013 and April 2014.Participants104 patients were assessed for eligibility. The study was conducted on 84 eligible patients.MethodsThe study sample consisted of 84 patients who underwent effective major abdominal surgery. The patients were randomized into two groups, the intervention group, which used an abdominal binder and the control group, which did not. Gastrointestinal function, mobilization, pulmonary function, and the pain status of both groups were evaluated on the first, fourth, and seventh days before and after surgery, and the intergroup results were compared.ResultsNo significant difference was found between the two groups in terms of gastrointestinal and pulmonary function on the first, fourth, and seventh days following surgery (p > 0.05). A comparative assessment of mobility by walking distance showed that patients in the intervention group were able to walk further on the fourth [mean (SD); 221.19 (69.08) m] and seventh [227.85 (60.02) m] days after surgery (p = 0.003, p < 0.001). There were differences in the acute pain status between patients in both groups (p < 0.05). On the first [mean (SD); 8.80 (5.03)], fourth [4.83 (2.78)], and seventh [3.09 (3.17)] days after surgery, the sensory sub-scale pain scores were higher in the control group (p < 0.001). On the first [mean (SD); 10.16 (6.14)], fourth [5.28 (3.52)], and seventh [3.30 (3.51)] days after surgery the total pain scores were higher in the control group (p < 0.001). The visual analogue scale scores were also higher in the control group on the first [mean (SD) 6.26 (1.86)], fourth [4.50 (2.10)], and seventh [3.04 (2.43)] days after surgery (p < 0.001).ConclusionThe study’s findings reveal that the use of an abdominal binder does not have any effect on postoperative gastrointestinal and pulmonary function. However, an abdominal binder increases patient mobility soon after surgery. There was also a measurable effect on pain, with lower scores reported by patients who used an abdominal binder after any exercise or activity. These results indicate that the use of a routine abdominal binder is helpful for patients undergoing major abdominal surgery.     

Inpatient palliative care and patient pain: pre- and post-outcomes

ContextHospitalized patients with serious illness often receive inadequate pain and symptom management at the end of life.ObjectivesTo test the effectiveness of an interdisciplinary inpatient palliative care (IPC) consultation program in the management of pain among seriously ill patients during hospitalization, and to examine IPC patient pain outcomes 10 days following hospital discharge.MethodsA two-year pre-post study was conducted at a nonprofit health maintenance organization medical center in Los Angeles County. Hospital patients (n = 484) aged 65 years and older with life-threatening, complex, chronic conditions received comprehensive assessment, pain and symptom relief, care planning, counseling, and other supportive services from an IPC team. Measures included self-reported pain at baseline, two and 24 hours following IPC intervention, discharge, and 10 days post-discharge.ResultsMean pain was significantly different between baseline (1.56 ± 2.79) and two hours (0.91 ± 1.59; P < 0.001), 24 hours (0.77 ± 1.58; P < 0.001), and hospital discharge (0.40 ± 1.09; P < 0.001). Mean pain 10 days after discharge (2.04 ± 2.79; P < 0.001) was significantly higher than mean pain at discharge. Number of chronic conditions, probability of mortality, and discharge to hospice care significantly predicted increased pain following discharge.ConclusionTo the authors’ knowledge, this is the first study to follow IPC patient pain after hospital discharge. Findings support IPC teams’ effectiveness in managing pain during hospitalization but suggest a lack of continuity in pain management following discharge. Research exploring IPC patient post-discharge transition experiences will likely improve understanding of post-discharge pain outcomes.     

Effects of auricular acupressure on pain and disability in adults with chronic neck pain

AimThe aim of this study was to examine the effect of auricular acupressure (AA) on pain, pain threshold (PT), disability, and cervical range of motion in adults with chronic neck pain.BackgroundAbout 30–50% of the world's population suffers from chronic neck pain, and the cost of treatment is increasing.Materials and methodsThis single-blind, randomized sham-controlled study was conducted on 48 adults with chronic neck pain in South Korea. The experimental group (n = 25) received AA on specific acupoints for neck pain, whereas the control group (n = 23) received AA on unspecific acupoints. Participants received 4 weeks of auricular-acupressure intervention. Outcomes were assessed by the visual analog scale (VAS), PT, neck-disability index (NDI), and cervical range of motion. Measurements were taken 3 times: before intervention, 2 weeks into the intervention, and after the intervention.ResultsStatistical differences between the two groups emerged in PT (p = .003), the NDI (p = .033), cervical flexion (p = .004), and left rotation (p = .004), but not on the VAS.ConclusionsThis study showed that AA leads to improvements on PT, neck disability, and cervical range of motion. Therefore, AA can be used as an alternative nursing intervention for chronic neck pain.     

The Effectiveness of Using a Nurse-Led Pain Relief Model for Pain Management among Abdominal Surgical Patients: A Single-Center,Controlled before-after Study in China

BackgroundEffective pain management is closely related to the prognosis of patients after surgery. Setting up acute pain service is among the effective strategies to control pain. The operation of acute pain service is mostly dominated by anesthesiologists; however, control of postsurgical pain is still unsatisfactory. Nurses are the main force for providing postoperative care of patients, and their role in acute pain service is crucial. Therefore, in the current study, we have developed a nurse-led pain relief model that emphasizes the central role of nurses during the entire surgical procedure. However, the effect of using this model for pain management among abdominal surgical patients remains unknown.AimsThe current study was conducted to investigate the effect of using a nurse-led pain relief model for pain management among abdominal surgical patients.DesignA single-center, propensity score-matched, controlled before–after study.MethodsThe patients, hospitalized for abdominal surgery in a university-affiliated hospital from January 2015 to December 2017, were enrolled and divided into group A (hospitalized before nurse-led pain relief model implementation, from January, 2015 to October, 2016) and group B (hospitalized after nurse-led pain relief model implementation, from October, 2016, to December, 2017) using propensity score match assay. The researchers compared the quality of acute pain management, the main side effects of pain management, and nurses’ pain knowledge and attitude between group A and group B.ResultsA total of 2851 patients undergoing nonemergency abdominal surgery were enrolled in the current study and were propensity matched 1:1 into two groups with 1,127 subjects in each group. The quality of acute pain management postsurgery was better after implementation of the nurse-led pain relief model. More patients received higher numerical rating scales cores (≥4 points) at indicated time points after surgery in group A compared with group B (14.20% vs. 12.24% 6 hours postsurgery, p = .001; 12.33% vs. 8.52% 12 hours postsurgery, p = .004; 12.95% vs. 3.99% 24 hours postsurgery, p = .036; 16.06% vs. 7.19% 48 hours postsurgery, p = .001). Furthermore, the occurrence of nausea and vomiting during pain management were significantly decreased in patients from group B (nausea: X² = 38.926, p < .05; vomit: X² = 39.302, p < .05). Additionally, after using the nurse-led pain relief model, nurses were more open to improving their knowledge and attitudes to pain management (p < .05).ConclusionOur study demonstrated that a nurse-led pain relief model can enhance the quality of acute pain management among post-abdominal surgical patients, suggesting that such a model can be an effective intervention for providing a better pain control among postsurgical patients.     

Investigating key predictors of persistent low back pain: A focus on psychological stress

AimTo investigate the degree to which psychological stress, self-reported pain scores, and pain sensitivity during an acute state of low back pain (LBP) predict the development of persistent LBP trajectories.BackgroundIdentifying which factors influence LBP trajectories is critical to understand why some individuals experience persistent LBP and to illuminate areas for nursing intervention.MethodsA secondary data analysis of a prospective study examining trajectories of LBP was conducted. The sample was comprised of 217 adults with acute-onset LBP recruited from the community and followed over 24 weeks. Variables of interest included demographic data, perceived stress scores, self-reported pain scores, and somatosensory characteristics collected within the first 4 weeks of LBP onset. The data were analyzed using non-parametric bivariate comparisons and a semi-parametric Cox proportional hazards model with interval-censoring.ResultsIndividuals with higher psychological stress scores were less likely to experience pain resolution (Hazard ratio [HR] = 0.555, 95% confidence interval [CI] = 0.36–0.85, p = 0.02). After adjustment for covariates in the final model, the analysis revealed household income (HR = 2.79, 95% CI [1.63–4.67], p < 0.001) to be the dominant predictor of LBP persistence in this sample.ConclusionHeightened psychological stress and pain severity as well as decreased pressure pain thresholds were indicated as influential factors of LBP trajectories. Household income was identified as the dominant predictor, demonstrating that individuals with a higher household income were more likely to resolve their pain. Strategies which integrate assessment of stress, self-reported pain scores, pain sensitivity, and social determinants for patients experiencing pain are needed to advance nursing care.     

Can muscle weakness and disability influence the relationship between pain catastrophizing and pain worsening in patients with knee osteoarthritis? A cross-sectional study

ObjectiveTo verify if the relationship between pain catastrophizing and pain worsening would be mediated by muscle weakness and disability in patients with symptomatic knee osteoarthritis.MethodsThis was a cross-sectional study in a hospital out-patient setting. Convenience sampling was used with a total of 50 participants with symptomatic knee osteoarthritis. Pain and the activities of daily livings (ADL) were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale. Pain catastrophizing was assessed using the Coping Strategy Questionnaire (CSQ) subscale. Muscle strength of knee extension and 30-s chair stand test (30CST) were also assessed. Path analysis was performed to test the hypothetical model. Goodness of fit of models were assessed by using statistical parameters such as the chi-square value, goodness of fit index (GFI), adjusted goodness of fit index (AGFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA).ResultsThe chi-square values were not significant (chi-square = 0.283, p = 0.594), and the indices of goodness of fit were high, implying a valid model (GFI = 1.000; AGFI = 0.997; CFI = 1.000; RMSEA = 0.000). Pain was influenced significantly by muscle strength and ADL; muscle strength was influenced significantly by ADL via 30CST; ADL was influenced by pain catastrophizing.ConclusionThe relationship between pain catastrophizing with pain worsening are mediated by muscle weakness and disability.     

Analgesic efficacy of the serratus anterior plane block in rib fractures pain: A randomized controlled trial

BackgroundSerratus anterior plane block (SAPB) was evaluated that in patients with the complaint of rib fracture pain in terms of total analgesic consumption and pain scores.MethodSixty patients with rib fracture and NRS (Numeric Rating Scala) pain scores equal or greater than four were included in randomized controlled study. Patients were randomized to perform SAPB or control group. Primary outcome was total tramadol consumption in 24 h. Secondary outcomes were NRS scores (after Patient Controlled Analgesia (PCA) application 30 min, first, second, 4 th, 6 th, 12 th, 24 th hour), peripheral oxygen saturation (first and 24 th hour after PCA application), chronic pain. and complications.ResultsThe total tramadol consumption significantly lower in group S (p = 0.02). NRS scores after 30 min, 1 h, 2 h, 4 h, 6 h, 12 h, and 24 h were significantly lower in group S than in group C (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.002, p = 0.026). The total number of patients who reported of chronic pain at rest and during effort was significantly lower in group SAPB than in group C (p = 0.006). Nine patients in group C were reported of pain, four of whom had pain at rest and five had pain during effort. One patient in group S was reported of pain during effort.ConclusionThis study demonstrated that SAPB, as part of multimodal analgesia in pain management due to rib fractures, is safe and effective in reducing acute pain.     

Longitudinal Trends in the Treatment of Abdominal Pain in an Academic Emergency Department

Background

Abdominal pain is a top chief complaint of patients presenting to Emergency Departments (ED). Historically, uncertainty surrounded correct management. Evidence has shown adequate analgesia does not obscure the diagnosis, making it the standard of care.

Objective

We sought to evaluate trends in treatment of abdominal pain in an academic ED during a 10-year period.

Methods

We prospectively evaluated a convenience sample of patients in an urban academic tertiary care hospital ED from September 2000 through April 2010. Adult patients presenting with a chief complaint of abdominal pain were included in this study. Analgesic administration rates and times, pain scores, and patient satisfaction at discharge were analyzed to evaluate trends by year.

Results

There were 2,646 patients presenting with abdominal pain who were enrolled during the study period. Rates of analgesic administration generally increased each year from 39.9% in 2000 to 65.5% in 2010 (p value for trend <0.001). Similarly, time to analgesic administration generally decreased by year, from 116 min in 2000 to 81 min in 2009 (p < 0.001). There was no improvement in mean pain scores at discharge by year (p = 0.27) and 48% of patients during the 10-year period still reported moderate to severe pain at discharge. Patient satisfaction with pain treatment increased from a score of 7.1 to 9.0 during the study period (p < 0.005), following the trend of increase in analgesic administration.

Conclusions

In patients presenting to the ED with abdominal pain, analgesia administration increased and time to medication decreased during the 10-year period. Despite overall improvements in satisfaction, significant numbers of patients presenting with abdominal pain still reported moderate to severe pain at discharge.