Pain management after discharge from the emergency department

Abstract

Study objectives: Inadequate pain management in the emergency department (ED) is well documented. Poor pain management may continue after ED discharge but has not been well studied. This study evaluates pain intensity for ED patients 1 week after discharge and the impact of prescribed medications on this pain experience. Methods: This was a prospective, observational study performed in an academic ED with a volume of 32,000 patients. A convenience sample of patients presenting with pain was enrolled from September 2002 to April 2003. Those excluded were younger than 18 years or too ill to participate. Pain intensity was measured using an 11-point (0 to 10) previously validated verbal numeric rating scale. Patients were contacted by telephone 1 week after their ED visit. Trained research associates performed all data collection and telephone contact. Significance of results was determined using χ 2 analysis and 95% confidence intervals (CIs). Results: Four hundred fifty-six patients were enrolled. Three hundred twenty-six (71%) patients were contacted. One hundred ninety-one (59%) were women, with an average age of 38 years. There were no significant differences ( P Conclusion: Patients continue to have high levels of average and worst pain 1 week after discharge from the ED. The use of prescription pain medication did not provide pain relief when average pain at follow-up to pain at discharge were compared. Even with the use of prescribed pain medication, worst pain at follow-up was significantly higher than pain at discharge. Further study of discharge pain management plans and patient use of prescribed pain medications is needed to improve analgesia after ED discharge. Limitations include convenience sampling and relatively low contact for follow-up.