American Pain Society Patient Outcome Research Articles

Pain prevalence and pain management practices in a university hospital: a descriptive, point prevalence study

Pain is both prevalent and severe in hospitals with subsequent delay in recovery and diminished quality of life. The aim of this descriptive, point prevalence study was to assess pain prevalence and pain management practices in a University hospital. Data were collected with the Icelandic version of the American Pain Society Patient Outcome Questionnaire and from medical charts. The time frame was the past 24 hours. Included were patients hospitalized for ≥24 hours, ≥18 years old, Icelandic speaking, alert, and able to participate. The response rate was 76.8%. Participants’ (N=368) age ranged from 18-100, the mean age was 67.6 years (SD = 17.4) and 50.6% were women. The mean worst pain severity (0-10 scale) was 4.5 (SD=3.2), and 80.4% of patients reported pain in the past 24 hours (≥1 on 0-10 scale). Severe pain (≥7 on 0-10) was reported by 33.0 % of participants. The mean worst pain severity of patients in pain was lower in men, 5.2 (SD=2.5) compared to women, 6.0 (SD=2.4), p<0.05. Pain prevalence was higher in women (87.2%) compared to men (78.1%), in patients 18-74 old (86.8%) compared to 75 years and older (77.6%), and on surgical services (90.5%) compared to medical (76.3%), p<0.05. The majority of patients (67.6%) received pain medications in the past 24 hours, and 34.4% used non-pharmacological methods to treat their pain, most often distraction (38.7%). Pain assessment with standardized methods was performed in 11.5% of participants, and in 37.2% the Pain Management Index was negative, indicating inadequate treatment. The pain prevalence was high in the hospital and a considerable proportion of patients had experienced severe pain in the past 24 hours. Standardized pain assessments were rare and pain treatment was insufficient in many instances. The pain management needs to be improved. The study was sponsored by the Icelandic Research Fund.

Jordanian Patients' Satisfaction with Pain Management

Pain is still undertreated among hospitalized patients. Recently, patient satisfaction with pain management has received significant attention. This field has not yet been explored among Jordanian patients. The purpose of this study was to determine the knowledge regarding pain characteristics, beliefs, and satisfaction that can be included in planning pain management strategies and protocols within Jordanian hospitals. Using descriptive cross-sectional methodology, the American Pain Society Patient Outcome Questionnaire (APS-POQ) was used to survey 375 inpatients from Jordanian hospitals. Participants reported relatively severe pain and pain interferences while being hospitalized and seemed to be well informed regarding pain and pain management. Participants reported high levels of pain management satisfaction. Also, the Arabic version of the APS-POQ was found to be reliable among the Jordanian population. Findings of this study are similar to those reported by earlier studies in other countries and support the need for applying the caring attitude in managing patients' reports of having pain. This study is the first in Jordan, opening the door for future studies to be conducted in this important field.

The Impact of Early PostOperative Pain on Health‐Related Quality of Life

To examine how the severity of postoperative pain affects patient's health-related quality of life (HRQoL) at 1week following surgery and to compare two generic validated HRQoL instruments. Patients undergoing general or orthopaedic surgery at the Royal London Hospital were randomly sampled. The following patient outcome data were collected EQ-5D (EuroQoL) pre-operatively and the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) at 24hours postoperation; and EQ-5D, Short-Form-12 (SF-12) and APS-POQ-R at 7days postoperation. The degree of association between pain and HRQoL was assessed using Pearson's correlation coefficient and multivariate generalized linear regression models. Of the 228 patients included, 166 patients provided data at 7days. Sixteen percent reported severe pain ≥50% of the day at 7days. The severity of pain on both the APS-POQ-R pain severity and interference and affective impairment domains at 7days was highly correlated with a decrease in HRQoL as assessed by the SF-12 Physical Component Score (PCS), SF-12 Mental Component Score (MCS), and EQ-5D scores (r=-0.34 to -0.61, P<0.0001). Multivariate regression analyses showed that irrespective of confounding factors (eg, age, gender, and pre-operative HRQoL) patients with severe postoperative pain experience important reductions in both physical and mental well-being domains of their HRQoL. A proportion of patients continue to experience severe pain at 7days postoperatively, even after minor surgery. HRQoL is strongly associated with the level of pain and provides additional data on the impact of postsurgery pain on patient's function and well-being. Additional studies are needed to elucidate the interaction between pain severity and HRQoL during the peri-operative period.

Evaluating the Quality of Pain Management in a Hospital Setting: Testing the Psychometric Properties of the Icelandic Version of the Revised American Pain Society Patient Outcome Questionnaire

Pain management is an important aspect of providing quality health care, and monitoring patient-related outcomes is a recommended quality improvement practice. Valid and reliable tools are needed for this purpose. The American Pain Society Patient Outcome Questionnaire (APS-POQ) is widely used to measure quality of pain management. The APS-POQ was recently revised to reflect advances in pain management. The purpose of this study was to test the psychometric properties of the revised version in Icelandic patients in the hospital setting. The questionnaire was translated according to an adaptation of Brislin's model. Data were collected from 143 patients on 23 wards in a university hospital. Participants were ≥18 years old, hospitalized for >24 hours, alert, not too ill to participate, and in pain ≥1 on a 0-10 scale in the past 24 hours. Mean (SD) age was 66 (18) years, 51.4% were women, 48.6% men. Principal component analysis with varimax rotation confirmed a five-component structure, but four items lowered reliability and were removed from the scales. The final version consists of four components, with Cronbach α >.70, explaining 64.2% of the variance. Participants had little difficulty in answering the questionnaire, but two additional items about participation in decisions and pain medications were added in response to patients' comments and suggestions. Administering the Icelandic version of the APS-POQ-R was found to be feasible, and the questionnaire has acceptable construct validity and reliability. The results support the use of the APS-POQ-R-I to evaluate the quality of pain management in hospitals in Iceland.

Pain and satisfaction in hospitalized trauma patients

Unmanaged pain has been found to predict delayed return to work, psychologic distress, and chronic pain and disability in patients with traumatic injury. However, little is known about the pain experience during hospitalization. The primary objective of this study was to determine pain intensity, pain interference, and satisfaction with pain treatment in orthopedic trauma patients at hospital discharge. A secondary objective was to examine whether patient self-efficacy and psychologic distress were associated with pain and satisfaction. Two hundred thirty-three orthopedic trauma patients were enrolled and completed a discharge assessment at a Level I trauma center. Pain was measured with the Brief Pain Inventory and satisfaction with the American Pain Society Patient Outcome Questionnaire. Ninety-seven percent of patients reported pain at the time of hospital discharge, with 59% and 73% reporting moderate to severe pain intensity and interference, respectively. Overall, 86% of patients were satisfied with pain treatment. Multivariable regression analyses demonstrated that decreased self-efficacy was associated with moderate to severe pain intensity, increased depression was associated with moderate to severe pain intensity and interference, and increased pain intensity was associated with decreased satisfaction (p < 0.05). Results suggest that orthopedic trauma patients have a significant pain burden but are satisfied with pain treatment during the hospital stay. Efforts are needed to improve pain assessment and management and findings imply that addressing self-efficacy and depressive symptoms may decrease pain and increase satisfaction at hospital discharge. Brief educational interventions that incorporate pain coping skills and self-management techniques may be a feasible approach to improving self-efficacy in the acute care setting. Additional recommendations include routine hospital screening for depression and increased communication between surgeons and mental health providers to identify patients at high risk for unmanaged pain and facilitate provision of early mental health services.

Colorectal Surgery Patients’ Pain Status, Activities, Satisfaction, and Beliefs about Pain and Pain Management

This study describes surgical colorectal cancer patients’ pain levels, recovery activities, beliefs and expectations about pain, and satisfaction with pain management. A convenience sample of 50 adult inpatients who underwent colorectal surgery for cancer participated. Patients were administered the modified American Pain Society Patient Outcome Questionnaire on postoperative day 2 and asked to report on their status in the preceding 24 hours. Patients reported low current (mean 1.70) and average (mean 2.96) pain scores but had higher scores and greater variation for worst pain (mean 5.48). Worst pain occurred mainly while turning in bed or mobilizing, and 25% of patients experienced their worst pain at rest. Overall, patients expected to have pain after surgery and were very satisfied with pain management. Patients with worst pain scores >7 reported interference with recovery activities, mainly general activity (mean 5.67) and walking ability (mean 5.15). These patients were likely to believe that “people can get addicted to pain medication easily” (mean 3.39 out of 5) and that “pain medication should be saved for cases where pain gets worse” (mean 3.20 out of 5). These beliefs could deter patients from seeking pain relief and may need to be identified and addressed along with expectations about pain in the preoperative nursing assessment.

Effects of Auricular Acupressure on Pain Reduction in Patient-controlled Analgesia After Lumbar Spine Surgery

This study aimed to examine the adjuvant effects of auricular acupres-sure in augmenting intravenous patient-controlled analgesia with morphine and droperidol for postoperative lumbar surgery patients in terms of postoperative pain relief satisfaction, and the incidence of postoperative nausea and vomiting (PONV). In this single-blind experimental study, 94 subjects were randomly assigned to the experimental group in which patients received auricular acupressure to six auricular acupoints or a control group without acupressure. Data were collected using the American Pain Society Patient Outcome Questionnaire. Descriptive analyses, t tests, chi(2) tests, Mann-Whitney tests, and the generalized estimating equation model were used. The experimental group had lower average pain scores than the control group, but no between-group difference was found. Analgesic dose and satisfaction were similar in both groups. The incidence of PONV was low and similar in both groups. Although this study did not demonstrate adjuvant effects of auricular acupressure on postoperative pain, analgesic dose, analgesic satisfaction and PONV, most subjects were satisfied with the pain management even though they were subjected to moderate pain because of insufficient analgesia. Further studies should reconfirm the effects of auricular acupressure on analgesia provided by intravenous patient-controlled analgesia in postoperative patients, and its influence on the frequency and duration of analgesia administration.

Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) for Quality Improvement of Pain Management in Hospitalized Adults: Preliminary Psychometric Evaluation

Quality improvement (QI) is a compilation of methods adapted from psychology, statistics, and operations research to identify factors that contribute to poor treatment outcomes and to design solutions for improvement. Valid and reliable measurement is essential to QI using rigorously developed and tested instruments. The purpose of this article is to describe the evolution of the American Pain Society Patient Outcome Questionnaire (APS-POQ) for QI purposes and present a revised version (R) including instrument psychometrics. An interdisciplinary task force of the APS used a step-wise, empiric approach to revise, test, and examine psychometric properties of the society's original POQ. The APS-POQ-R is designed for use in adult hospital pain management QI activities and measures 6 aspects of quality, including (1) pain severity and relief; (2) impact of pain on activity, sleep, and negative emotions; (3) side effects of treatment; (4) helpfulness of information about pain treatment; (5) ability to participate in pain treatment decisions; and (6) use of nonpharmacological strategies. Adult medical-surgical inpatients (n = 299) from 2 hospitals in different parts of the United States participated in this study. Results provide support for the internal consistency of the instrument subscales, construct validity and clinical feasibility. This article presents the initial psychometric properties of the APS-POQ-R for quality improvement purposes of hospitalized adult patients. Validation in additional groups of patients will be needed to demonstrate its generalizability.

Core Aspects of Satisfaction with Pain Management: Cancer Patients' Perspectives

Context The coexistence of high levels of satisfaction and high levels of pain has been perplexing. Objectives The aims of this study were to 1) describe patient expectations related to the experience of cancer-related pain, 2) explore the cognitive processes and meaning that underlie patient judgments about satisfaction and dissatisfaction with pain management, and 3) explore the discrepancies between ratings of high satisfaction with pain management with high pain intensity. Methods The sample included 33 patients: 18 with advanced cancer and 15 experiencing pain after a surgery for a cancer diagnosis. All patients had experienced “worst pain” of at least moderate intensity and were interviewed using standard pain measures from the American Pain Society Patient Outcome Questionnaire and open-ended questions about the underlying meaning of their answers. We systematically analyzed the transcribed qualitative data using NVivo software. Results Fifty-five percent of patients were females and were aged 25–78 years. Most (75%) were satisfied or very satisfied with their overall pain management. Key findings indicate that for some, the worst pain rating was often brief, even momentary. Most patients expected pain relief. Four key themes were important to the quality of pain management: being treated right, having a safety net, being in a partnership with their health care team, and having pain treatment that was efficacious. Key aspects of the patient-provider relationship that mattered were how the nurses and doctors behaved toward them and how quickly they responded to reports of pain. For some, an important factor was whether they had control of the amount of pain they experienced. Conclusion The findings inform measurement of patient satisfaction with the quality of pain management.

Pain Prevalence Study in a Large Canadian Teaching Hospital. Round 2: Lessons Learned?

Pain prevalence is an important indicator of quality patient care, representing a basis upon which improvement efforts may be developed. Based on results of an original pain prevalence survey at our institution in 2006, a follow-up prevalence study was conducted in November 2007. Pain and its interference with patients’ activities, patient satisfaction with pain management efforts, prescribing practice, and perceived barriers to pain control were all studied using a modified version of the American Pain Society Patient Outcomes Questionnaire. Methodologic objectives included improving the response rate from the earlier study and collecting additional demographic data. A 58% response rate was achieved. Pain prevalence at the time of the survey was 84%, and 25.8% of patients experienced severe pain, on average, over the previous 24 hours. Patients were generally quite satisfied with pain management efforts. Of particular interest were the prescribing practices. Only 50% of patients studied on the medical units had a PRN opioid order. These results reinforce those of our original prevalence study, specifically, that pain is not well controlled at our institution.

The Norwegian version of the American pain society patient outcome questionnaire: reliability and validity of three subscales

To examine some psychometric properties of the Norwegian version of the American Pain Society's Patient Outcome Questionnaire(APS-POQ-N). This study is part of an investigation of Norwegian orthopaedic surgical patients, where the overall aim is to evaluate the quality of postoperative pain management. Therefore, an adequate questionnaire on the quality of postoperative pain management was needed. The sample included 114 orthopaedic postoperative patients. The instrument consists of three main subscales, namely the modified Brief Pain Inventory(modified BPI subscale), the subscale on satisfaction with pain management(Satisfaction subscale) and the subscale on beliefs about pain management (Beliefs subscale), together with six single items about pain management. The reliability of these three main subscales was estimated using Cronbach's alpha coefficients and the construct validity was evaluated using principal-axis factor analysis with oblimin rotation. Face and content validity of the APS-POQ-N were satisfactory, while the modified BPI and the Beliefs subscales showed acceptable internal consistency but the Satisfaction subscale did not. Factor analyses yielded a three-factor solution for the modified BPI, a one-factor solution for the Satisfaction subscale and a two-factor solution for the Beliefs subscale. The APS-POQ-N appears, in general, to be an acceptable method of evaluating postoperative pain management in orthopaedic postoperative patients.However, the alpha value of the Satisfaction subscale was low, and thus the subscale is not recommended for this purpose.

Patients' experiences of cardiology procedures using minimal conscious sedation

The study's purpose was to describe patients' experiences of minimal conscious sedation during diagnostic and interventional cardiology procedures. Over a 6-week period, 119 consecutive patients (10% of annual throughput) from a major metropolitan hospital in Melbourne, Australia, were interviewed using a modified version of the American Pain Society Patient Outcome Questionnaire. Patients identified pain severity using a 10-point visual analogue scale and rated their overall comfort on a 6-point Likert scale ranging from very comfortable to very uncomfortable. Patients were aged 67.6 years (standard deviation 11.1), 70.8% were male, and the mean body mass index was 27.7 (standard deviation 4.8). Patients underwent diagnostic coronary angiography (67.5%), percutaneous coronary interventions (13.3%), or combined procedures (19.2%). Most patients (65%) were comfortable in the context of low-dose conscious sedation. Slight discomfort was reported by 26% of patients; 9% reported feeling uncomfortable primarily as a result of a combination of musculoskeletal pain, angina, and vasovagal symptoms experienced during the procedure. There was significant correlation (rho = .25, P = .01) between procedure length and patients' report of overall comfort, suggesting longer procedures were less comfortable for patients. The minimal sedation protocol was effective for the majority of patients; however, 9% of patients experienced significant discomfort related to preexisting conditions, highlighting the need for individual patient assessment before, during, and after the procedure.

The effects of epidural catheter location on outcomes in women undergoing gynaecologic surgery with an abdominal incision: A randomised clinical trial

Summary Introduction Currently, there is no standard location for the placement of epidural catheters in patients undergoing abdominal gynaecologic surgery. Methods Adult women undergoing elective gynaecologic surgery with abdominal incision were prospectively enrolled in a randomised double-blind controlled trial comparing postoperative outcomes for lumbar epidural analgesia (LEA) versus thoracic epidural analgesia (TEA). Motor function, proprioception, cold sensation, pain, American Pain Society (APS) Patient Outcome Questionnaire (Modified), Brief Fatigue Inventory (BFI) and Quality of Recovery 9 (QOR9) were assessed. Results A total of 103 patients enrolled with 88 completing the study. There were no significant differences in demographics, pain scores during hospital stay or nausea/vomiting. Motor blockade was less with TEA compared to LEA but was statistically significant only for right knee extension and flexion and straight leg raise. There was a statistically significant decrease in pruritus with LEA. Subgroup analysis by surgical incision demonstrated a statistically significant decrease in pain scores for TEA for vertical incisions extending above the umbilicus only. Pain scores reported by the patients 7 days after surgery were higher both at rest and maximal for TEA. Conclusions Lower abdominal procedures for gynaecologic surgery do not appear to require TEA for optimal care unless upper abdominal incision is used or catheters will remain in place greater than 24 h.

Using a patient‐controlled analgesia multimedia intervention for improving analgesia quality

To evaluate the effects of analgesia quality provided by a patient-controlled analgesia multimedia intervention on the pain management of postsurgical patients in Taiwan. The concept of patient-controlled analgesia has become the mainstream pain treatment method because of its characteristic of instant self-administering medication. It is an important mission of nursing professionals to communicate effective and correct knowledge of patient-controlled analgesia on how to relieve pain and improve quality of care. A quasi-experiment research design was used for this study. Sixty subjects recruited from a medical teaching centre of Taiwan were assigned into either the experimental (n = 30) or control group (n = 30). The experimental group received the patient-controlled analgesia multimedia intervention. The control group only received one-on-one patient education of routine nursing guide and pain management with pamphlet. The pain cognition and American Pain Society patient outcome questionnaires were used as measures of effects for the interventions. The results showed the experimental group, compared with the control group, had significant improvement in pain cognition and analgesia quality. There is significant correlation between pain cognition and analgesia quality. After intervening, the patients approved of the patient-controlled analgesia multimedia intervention and affirmed the value of early acquisition of such information to their postsurgical treatments and recoveries. The higher the pain cognition patients obtained, the better the analgesia quality patients had. Applying the patient-controlled analgesia multimedia intervention for surgical patients to improve pain cognition, the utility of patient-controlled analgesia, pain relief and patient satisfaction is recommended.

The hidden error of mismanaged pain: a systems approach

Undertreatment of pain resulting in physiological, psychosocial, and economic consequences continues despite targeted improvement approaches. Starck et al. propose a systems framework for study of pain management errors. This secondary analysis examined pain outcomes of hospitalized inpatients to determine factors predicting adequate pain management. Data were collected from 964 hospitalized adult patients in the southwestern United States. The American Pain Society Patient Outcome Questionnaire and a demographic and chart audit form were used to collect data. The Pain Management Index (PMI) was computed for all participants. Results revealed that 30% of patients were undertreated for pain, with 67.5% reporting severe worst pain ratings (7 on a 0–10 scale). Non-whites, the elderly, and women had significantly higher pain ratings and higher proportions of negative PMI scores. Logistic regression predicted adequate pain management based on analgesic rating, ethnicity, age, and educational level with 0.89 accuracy. The study findings support conceptualizing mismanagement of pain as a medical error. An intervention model describes the use of a systems approach to identify high risk patients and ensure effective pain management practices for all.

Changing Acute Pain Management Outcomes in Surgical Patients

Patient outcome studies indicate that patients accept pain as part of hospitalization. The majority of hospitalized patients who report experiencing pain are recovering from surgical intervention. To achieve successful outcomes, a comprehensive multidisciplinary effort must begin preoperatively and continue through discharge. The perioperative period is an essential link in effective pain management, and perioperative nurses are key in helping direct the care of surgical patients before, during, and after surgical procedures. Pain relief and the patients satisfaction with care frequently are used to measure pain management outcomes. This article examines the results of a secondary analysis of a subset of surgical patients drawn from a larger data set that was collected during two studies in urban and rural hospitals. It focuses on two outcomes, namely characteristics of pain and patient satisfaction with pain management after surgery. These outcomes were measured using the American Pain Society patient outcome questionnaire and the pain management index. Correlational, descriptive, and regression analyses indicate that postoperative management of patients' pain in these studies was less than optimal. From this new understanding, strategies for effective pain management of surgical patients are recommended.

Efficacy and tolerability of celecoxib versus hydrocodone/acetaminophen in the treatment of pain after ambulatory orthopedic surgery in adults

Background: Current outpatient management of postoperative pain includes the use of oral opioid analgesics or nonsteroidal anti-inflammatory drugs; however, both types of medications are associated with side effects that can limit their usefulness in the outpatient setting. Objective: Two studies with identical protocols assessed the single- and multiple-dose analgesic efficacy and tolerability of celecoxib, a specific cyclooxygenase-2 inhibitor, in the treatment of acute pain after orthopedic surgery. Methods: These were multicenter, randomized, placebo- and active-controlled, double-blind, parallel-group trials conducted between January and June 1998. Both consisted of a single-dose assessment period (SDAP) and a multiple-dose assessment period (MDAP). In the SDAP, patients who had undergone orthopedic surgery received a single oral dose of celecoxib 200 mg, hydrocodone 10 mg/acetaminophen 1000 mg, or placebo within 24 hours after the end of anesthesia, with pain assessments conducted over the following 8-hour period. In the MDAP, extending from 8 hours after the first dose of study medication up to 5 days, patients who had received ≤1 dose of rescue medication during the SDAP continued on study medication (placebo recipients were rerandomized to active treatment), which could be taken up to 3 times a day as needed. Results: A total of 418 patients were enrolled in the 2 trials. During the SDAP, 141 patients received celecoxib, 136 received hydrocodone/acetaminophen, and 141 received placebo. During the MDAP, 185 patients received celecoxib and 181 received hydrocodone/acetaminophen. When the combined data were analyzed, mean pain intensity difference (PID) scores generally favored the active treatments over placebo from 1 to 6 hours (with the exception of 1.5 hours) after dosing ( P ≤ 0.016) and favored celecoxib over the other treatments at 7 and 8 hours after dosing ( P < 0.001). The active treatments demonstrated superior summed PID scores through 8 hours ( P < 0.001), significantly shorter median times to onset of analgesia ( P < 0.05), and significantly longer median times to first use of rescue medication ( P < 0.05). During the MDAP, more hydrocodone/acetaminophen-treated patients (20%) than celecoxib-treated patients (12%) required rescue medication ( P < 0.05), and the celecoxib group had significantly lower maximum pain intensity scores ( P < 0.001, days 2–5), required fewer doses of study medication ( P ≤ 0.01, days 3–5), and had superior scores on a modified American Pain Society Patient Outcome Questionnaire ( P ≤ 0.013). In addition, a significantly lower proportion of celecoxib-treated patients experienced adverse events (43%) compared with hydrocodone/acetaminophen-treated patients (89%; P < 0.001). Conclusions: Over 8 hours, patients with moderate to severe pain after orthopedic surgery experienced comparable analgesia with single doses of celecoxib and hydrocodone/acetaminophen. Over a 5-day period, oral doses of celecoxib 200 mg taken 3 times a day demonstrated superior analgesia and tolerability compared with hydrocodone 10 mg/acetaminophen 1000 mg taken 3 times a day. Most patients required no more than 2 daily doses of celecoxib 200 mg for the control of their postorthopedic surgical pain.

Qualitative assessment of hospitalized patients' satisfaction with pain management.

Patient evaluations of effectiveness of care and satisfaction with care are useful outcome indicators of pain management. The subiective, multidimensional nature of pain is best evaluated when outcome measures include the richness of qualitative data to more fully capture the range of patient experiences. A descriptive qualitative component was added to the American Pain Society Patient Outcome Questionnaire--Modified (1995) to determine critical indicators in the pain experience affecting patient satisfaction. Four themes emerged from the data as factors affecting patient satisfaction or dissatisfaction: Patient Pain Experience, Patient Views of Health Care Providers, Patient Pain Management Experiences, and Pain Management Outcomes. The result is a typology of factors affecting patient reports of satisfaction. Satisfaction was most likely when providers effectively addressed pain control with the patient as an informed partner. Patients expressed dissatisfaction, even when pain was relieved, when providers appeared uncaring, were slow to respond, or lacked knowledge and skill. Our results offer clinicians new insights into how patients respond to pain, which could enable development of patient-oriented approaches to pain management improving quality and effectiveness of care and increasing patient satisfaction.

Assessing Clinical Outcomes: Patient Satisfaction with Pain Management

The problem of unresolved pain in hospitalized patients is costly both in monetary terms and in patient comfort. Concern about patients’ satisfaction and well-being led to a study to determine the characteristics of the pain experience as reported by the hospitalized patients. This study also examined the recently revised American Pain Society Patient Outcome Questionnaire (APS-POQ), particularly in regard to results from newly added items and overall reliability and validity. The data provide a cross-sectional description of patients’ experience with pain in a large, urban teaching hospital. One hundred fifty-seven adult subjects reported moderate to high levels of current pain intensity, worst pain, and general level of pain in the last 24 hr, as well as moderate to high rates of pain-related interference with care activities. While patients indicated that they were satisfied with their pain management and with the responses of physicians and nurses to complaints of pain, patient satisfaction was inversely and significantly correlated with pain now and general level of pain in the last 24 hr. When patients with high pain intensity (>7) were separated into satisfied and dissatisfied groups for analysis, no significant differences were found regarding pain-related interference with various activities including mood, relationships, sleep, etc. The majority of patients indicated that they were still in pain, but 41% did not wish to receive a stronger dose of pain medication. Significant differences between those who did and did not want more pain medication were found in that younger patients were more likely to want more pain medication. Additionally, analysis of these two groups found that patients who were still in pain and desired more pain medication reported significantly higher levels of pain-related interference with activity and sleep. The inverse correlation of current pain intensity and general level of pain with overall satisfaction with pain management differs from findings of previous studies. One added item queried patients regarding approaches they had used to manage pain in the last 24 hr. Oral pain medications, prayer, intravenous and intramuscular injections were the top-ranked methods. The findings guide further analysis of the APS-POQ questionnaire. Recommendations of items to be retained in the questionnaire are made based on data analysis. Refining the questionnaire will allow health-care providers to increase their understanding of issues related to pain management. The findings provoke several questions for further study, such as what are age and ethnic differences regarding pain intensity and satisfaction, as well as the predictors of aversion to receiving more pain medication when pain persists.