Pain and pain management the first two weeks after trauma.

Abstract

Severe pain following trauma has traditionally been treated with opioids. We wanted to investigate the incidence of pain in patients at our trauma centre, the type of pain relief they were given in the first two weeks after admission and the subsequent plan for pain management upon discharge. The study included 40 severely injured adult patients who were conscious at admission. Data were obtained from the trauma register at Oslo University Hospital, from patient records and from interviews with all patients approximately two weeks after the injury was incurred. The patients were asked to indicate pain intensity from 0 to 10 on a verbal numeric rating scale (VNRS). The average resting pain score was higher than 3 in the two-week period after the injury in 38% of the patients, and 48% reported having had a score higher than 3 for more than half of this period. All patients were treated with opioids and paracetamol during their hospital stay. In addition, 78% received epidural analgesics or nerve blockers, 35% received ketamine, 28% non-steroidal anti-inflammatory drugs (NSAIDs), 23% alpha-2 agonists and 10% gabapentinoids. Seventy-eight per cent were prescribed opioids upon discharge with no mention of a tapering plan in their discharge report. Severely injured patients experience substantial pain in the first two weeks after trauma. Pain management in hospitals has room for improvement, and plans should be devised for opioid use and cessation after discharge.