Abstract
Introduction: Pain is the most common chief complaint of patients presenting to Emergency Department (ED). Pain is not simply a signal for tissue injury, but also a signal to seek repair and recuperation. The aim of this study was to determine whether upper limb (UL) or lower limb (LL) fracture has more pain and to evaluate the association between types of fracture (UL vs LL) with adequacy of pain relief. 
 Methodology: A study was conducted from July to October 2005 in ED, Hospital Universiti Sains Malaysia (HUSM). Patients who fulfill the inclusion criteria were selected. Paramedics in charged were the assistants; at the same time became the observer. The paramedics were not involved in the decision making for pain management. Pain severity score was assessed by using Numeric Rating Scale (NRS). 
 Results: 42 patients were enrolled. 85.7% (n=36) were male and 14.3% were female. Mean age is 29.6 years old. Mean NRS on arrival for UL and LL fractures were 6.47 ± 1.70 and 7.80 ± 2.53 respectively. Mean NRS for mixed fractures (both UL and LL) was 7.60 ± 3.36. There was no statistically significant association between fracture sites and analgesic administration (p value=0.300). There were 70.6% and 70.0% of the patients with UL and LL fractures had adequate pain relief whereas 80% of patients with mixed fractures had adequate pain relief (p value= 0.902). 
 Conclusion: LL and mixed fractures had more pain score on arrival but there was no statistically significant association between fracture sites and analgesics administration and no association between fracture sites with adequacy of pain relief.
Highlights
Pain is the most common chief complaint of patients presenting to Emergency Department (ED) [1]
As the incidence of fracture is expected to increase due to change in life style [6], its management should be of importance
Fracture leads to inflammatory response and releases of mediators that results in severe pain, requires efficient pain
Summary
Pain is the most common chief complaint of patients presenting to Emergency Department (ED) [1]. Pain is not a signal for tissue injury, and a signal to seek repair and recuperation. Any fractures cause significant pain to the patients and require immediate pain assessment and treatment [2]. Most fractures are caused by sudden and excessive force that lead to the bone breaks at the point of impact with damage of the soft tissues [3]. There is mechanical distortion of periosteum and pain signaling that lead to immediate sharp and intense pain [4]. Fracture leads to inflammatory response and releases of mediators that results in severe pain, requires efficient pain
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