Analgesic treatment and predictors of satisfaction with analgesia in patients with acute undifferentiated abdominal pain

• Published in: European journal of pain 2007-10, Vol.11 (7), p.773-778
• Main Authors: Marinsek, Matej, Kovacic, Dragan, Versnik, Darja, Parasuh, Milena, Golez, Slavica, Podbregar, Matej
• Format: Article
• Language: English
• Subjects: Abdominal pain; Abdominal Pain - diagnosis; Abdominal Pain - psychology; Abdominal Pain - therapy; Acute Disease; Adult; Aged; Analgesia - standards; Anesthesia & Perioperative Care; Emergency Medical Services - standards; Female; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Pain Measurement; Pain Medicine; Patient Satisfaction; Physician-Patient Relations; Predictive Value of Tests; Prospective Studies; Visual analogue scale
• ISSN: 1090-3801; 1532-2149
• DOI: 10.1016/j.ejpain.2006.12.002

Abstract The objectives of this prospective, observational cohort study were to examine current practice of analgesia in adults with acute abdominal pain presenting to emergency department (ED), to assess patient–physician agreement on pain severity, and to measure patients’ satisfaction with pain management. Methods Emergency room nurse assessed initial patient’s and physician’s ranking on a 0–100 mm visual analogue scale (VAS) as well as patient’s VAS rankings 5 min, 15 min, and 60 min after starting treatment for pain, and on discharge. In patients who received no therapy VAS scores were assessed 5 min, 15 min, and 60 min after initial examination, and on discharge. Patient’s satisfaction with pain management on discharge from ED was assessed using a four-point categorical scale in which 1 = completely unsatisfied, 2 = mostly unsatisfied, 3 = mostly satisfied, and 4 = completely satisfied. Results A total of 185 patients were enrolled. Patients’ mean initial VAS was higher than physicians’ (76 ± 20 mm, vs. 59 ± 20 mm, p < 0.001). Physician’s VAS ⩾60 mm was the sole independent predictor of receiving analgesic therapy ( p < 0.001). On discharge from ED, 111 patients (60%) were predominantly satisfied with analgesia (satisfaction score ⩾3). Drug titration ( p = 0.026) and decrease in VAS score ⩾20 mm between initial and discharge score ( p < 0.001) independently predicted patients’ satisfaction. Conclusions Patients with acute abdominal pain rated pain significantly higher than physicians who’s pain estimation in turn tailored analgesia. Only 60% of patients were satisfied with analgesia. Analgesic drug titration and a decrease of ⩾20 mm on VAS predicted patients’ satisfaction.