Pierik Jorien G J, IJzerman Maarten J, Gaakeer Menno I, Berben Sivera A, van Eenennaam Fred L, van Vugt Arie B, Doggen Carine J M
Health Technology & Services Research, MIRA institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede.
Emergency Department, Admiraal De Ruyter Ziekenhuis, Goes.
Pain Med. 2015 May;16(5):970-84. doi: 10.1111/pme.12668. Epub 2014 Dec 28.
While acute musculoskeletal pain is a frequent complaint in emergency care, its management is often neglected, placing patients at risk for insufficient pain relief. Our aim is to investigate how often pain management is provided in the prehospital phase and emergency department (ED) and how this affects pain relief. A secondary goal is to identify prognostic factors for clinically relevant pain relief.
This prospective study (PROTACT) includes 697 patients admitted to ED with musculoskeletal extremity injury. Data regarding pain, injury, and pain management were collected using questionnaires and registries.
Although 39.9% of the patients used analgesics in the prehospital phase, most patients arrived at the ED with severe pain. Despite the high pain prevalence in the ED, only 35.7% of the patients received analgesics and 12.5% received adequate analgesic pain management. More than two-third of the patients still had moderate to severe pain at discharge. Clinically relevant pain relief was achieved in only 19.7% of the patients. Pain relief in the ED was higher in patients who received analgesics compared with those who did not. Besides analgesics, the type of injury and pain intensity on admission were associated with pain relief.
There is still room for improvement of musculoskeletal pain management in the chain of emergency care. A high percentage of patients were discharged with unacceptable pain levels. The use of multimodal pain management or the implementation of a pain management protocol might be useful methods to optimize pain relief. Additional research in these areas is needed.
虽然急性肌肉骨骼疼痛是急诊护理中常见的主诉，但对其管理往往被忽视，使患者面临疼痛缓解不足的风险。我们的目的是调查在院前阶段和急诊科（ED）进行疼痛管理的频率以及这如何影响疼痛缓解。次要目标是确定临床相关疼痛缓解的预后因素。
这项前瞻性研究（PROTACT）纳入了697例因四肢肌肉骨骼损伤而入住急诊科的患者。使用问卷和登记册收集有关疼痛、损伤和疼痛管理的数据。
尽管39.9%的患者在院前阶段使用了镇痛药，但大多数患者到达急诊科时仍有剧烈疼痛。尽管急诊科疼痛发生率很高，但只有35.7%的患者接受了镇痛药治疗，12.5%的患者接受了充分的镇痛疼痛管理。超过三分之二的患者出院时仍有中度至重度疼痛。只有19.7%的患者实现了临床相关的疼痛缓解。与未接受镇痛药的患者相比，接受镇痛药的患者在急诊科的疼痛缓解情况更好。除了镇痛药外，损伤类型和入院时的疼痛强度与疼痛缓解有关。
在急诊护理链中，肌肉骨骼疼痛管理仍有改进空间。高比例的患者出院时疼痛水平令人无法接受。使用多模式疼痛管理或实施疼痛管理方案可能是优化疼痛缓解的有用方法。需要在这些领域进行更多研究。
