Lack of Influence of Patient Self-Report of Pain Intensity on Administration of Opioids for Suspected Long-Bone Fractures

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Abstract

The purpose of the present study was to prospectively investigate the extent to which emergency providers base their decisions about pain management of suspected long-bone fracture on patient's self-reported pain intensity. Of 100 long-bone fracture patients presenting to 2 inner-city emergency departments, 69% received opioids as compared to 30% of 110 patients without long-bone fracture (RR = 2.3; 95% CI 1.6 to 3.1). After stratification by pain ratings on a validated self-reported numerical rating scale, fracture patients remained twice as likely to receive opioids as those without fracture (RR = 2.0; 95% CI 1.5 to 2.7). Similarly, multivariate adjustment for self-reported pain intensity had little effect on the observed association (RR = 2.1; 95% CI 1.6 to 2.8). We conclude that emergency providers do not primarily base their decisions about pain management of suspected long-bone fractures on patient self-reporting of pain intensity. Perspective: This article addresses the question of the role of self-reported pain intensity rating on the treatment of suspected fractures. The findings indicate that self-reported pain is not used as the most important measure of pain as recommended by expert panels. We speculate this may contribute to oligoanalgesia in the Emergency Department.

Original languageEnglish (US)
Pages (from-to)438-444
Number of pages7
JournalJournal of Pain
Volume7
Issue number6
DOIs
StatePublished - Jun 2006

Fingerprint

Bone Fractures
Self Report
Opioid Analgesics
Pain
Pain Management
Hospital Emergency Service
Emergencies

Keywords

  • Analgesic
  • analgesic
  • fractures
  • nonnarcotic
  • opioid
  • pain

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology
  • Neurology
  • Nursing(all)

Cite this

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title = "Lack of Influence of Patient Self-Report of Pain Intensity on Administration of Opioids for Suspected Long-Bone Fractures",
abstract = "The purpose of the present study was to prospectively investigate the extent to which emergency providers base their decisions about pain management of suspected long-bone fracture on patient's self-reported pain intensity. Of 100 long-bone fracture patients presenting to 2 inner-city emergency departments, 69{\%} received opioids as compared to 30{\%} of 110 patients without long-bone fracture (RR = 2.3; 95{\%} CI 1.6 to 3.1). After stratification by pain ratings on a validated self-reported numerical rating scale, fracture patients remained twice as likely to receive opioids as those without fracture (RR = 2.0; 95{\%} CI 1.5 to 2.7). Similarly, multivariate adjustment for self-reported pain intensity had little effect on the observed association (RR = 2.1; 95{\%} CI 1.6 to 2.8). We conclude that emergency providers do not primarily base their decisions about pain management of suspected long-bone fractures on patient self-reporting of pain intensity. Perspective: This article addresses the question of the role of self-reported pain intensity rating on the treatment of suspected fractures. The findings indicate that self-reported pain is not used as the most important measure of pain as recommended by expert panels. We speculate this may contribute to oligoanalgesia in the Emergency Department.",
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author = "Bijur, {Polly E.} and Anick B{\'e}rard and David Esses and Jordan Nestor and Schechter, {Clyde B.} and Gallagher, {E. John}",
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T1 - Lack of Influence of Patient Self-Report of Pain Intensity on Administration of Opioids for Suspected Long-Bone Fractures

AU - Bijur, Polly E.

AU - Bérard, Anick

AU - Esses, David

AU - Nestor, Jordan

AU - Schechter, Clyde B.

AU - Gallagher, E. John

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N2 - The purpose of the present study was to prospectively investigate the extent to which emergency providers base their decisions about pain management of suspected long-bone fracture on patient's self-reported pain intensity. Of 100 long-bone fracture patients presenting to 2 inner-city emergency departments, 69% received opioids as compared to 30% of 110 patients without long-bone fracture (RR = 2.3; 95% CI 1.6 to 3.1). After stratification by pain ratings on a validated self-reported numerical rating scale, fracture patients remained twice as likely to receive opioids as those without fracture (RR = 2.0; 95% CI 1.5 to 2.7). Similarly, multivariate adjustment for self-reported pain intensity had little effect on the observed association (RR = 2.1; 95% CI 1.6 to 2.8). We conclude that emergency providers do not primarily base their decisions about pain management of suspected long-bone fractures on patient self-reporting of pain intensity. Perspective: This article addresses the question of the role of self-reported pain intensity rating on the treatment of suspected fractures. The findings indicate that self-reported pain is not used as the most important measure of pain as recommended by expert panels. We speculate this may contribute to oligoanalgesia in the Emergency Department.

AB - The purpose of the present study was to prospectively investigate the extent to which emergency providers base their decisions about pain management of suspected long-bone fracture on patient's self-reported pain intensity. Of 100 long-bone fracture patients presenting to 2 inner-city emergency departments, 69% received opioids as compared to 30% of 110 patients without long-bone fracture (RR = 2.3; 95% CI 1.6 to 3.1). After stratification by pain ratings on a validated self-reported numerical rating scale, fracture patients remained twice as likely to receive opioids as those without fracture (RR = 2.0; 95% CI 1.5 to 2.7). Similarly, multivariate adjustment for self-reported pain intensity had little effect on the observed association (RR = 2.1; 95% CI 1.6 to 2.8). We conclude that emergency providers do not primarily base their decisions about pain management of suspected long-bone fractures on patient self-reporting of pain intensity. Perspective: This article addresses the question of the role of self-reported pain intensity rating on the treatment of suspected fractures. The findings indicate that self-reported pain is not used as the most important measure of pain as recommended by expert panels. We speculate this may contribute to oligoanalgesia in the Emergency Department.

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