*Department of Emergency Medicine,Hôpital du Sacré-Coeur de Montréal,Montreal,QC.
†Center for Advanced Research in Sleep Medicine,Hôpital du Sacré-Coeur de Montréal,Montreal,QC.
CJEM. 2018 Jan;20(1):21-27. doi: 10.1017/cem.2017.2. Epub 2017 Mar 15.
The management of acute pain constitutes an essential skill of emergency department (ED) physicians. However, the accurate assessment of pain intensity and relief represents a clinically challenging undertaking. Some studies have proposed to define effective pain relief as the patient's refusal for additional analgesic administration. The aim of this study was to verify whether such a refusal is effectively indicative of pain relief.
This prospective cohort study included ED patients who received single or multiple doses of pain medication for an acute pain problem. Patients were evaluated for pain relief using one Likert scale and two dichotomous questions: Is your pain relieved? and Do you want more analgesics? Non-relieved patients were further analysed using a checklist as to the reasons behind their refusal for supplemental pain medication.
We have recruited 378 adult patients with a mean age of 50.3 years (±19.1); 60% were women and had an initial mean pain level of 7.3 (±2.0) out of 10. We observed that 68 out of 244 patients who were adequately relieved from pain asked for more analgesics (28%), whereas 51 out of 134 patients who were not relieved from pain refused supplemental drugs (38%). Reasons for refusal included wanting to avoid side effects, feeling sufficiently relieved, and disliking the medication's effects.
Over a third of ED patients in acute pain were not relieved but refused supplemental pain medication. Patients have reported legitimate reasons to decline further analgesics, and this refusal cannot be used as an indication of pain relief.
急性疼痛管理是急诊科（ED）医生的一项基本技能。然而，准确评估疼痛强度和缓解程度是一项具有临床挑战性的任务。一些研究提出，将患者拒绝额外镇痛剂的给药定义为有效的疼痛缓解。本研究旨在验证这种拒绝是否能有效地表明疼痛缓解。
这项前瞻性队列研究纳入了因急性疼痛问题接受单次或多次疼痛药物治疗的 ED 患者。采用一个 Likert 量表和两个二分问题评估患者的疼痛缓解情况：您的疼痛缓解了吗？您还需要更多的镇痛药吗？对于未缓解的患者，进一步通过检查表分析他们拒绝补充疼痛药物的原因。
我们共招募了 378 名平均年龄为 50.3 岁（±19.1）的成年患者；60%为女性，初始疼痛评分为 10 分制的 7.3（±2.0）分。我们观察到，244 名疼痛得到充分缓解的患者中有 68 名（28%）要求使用更多的镇痛药，而 134 名未缓解的患者中有 51 名（38%）拒绝使用补充药物。拒绝的原因包括担心副作用、感觉已经足够缓解以及不喜欢药物的作用。
超过三分之一的急性疼痛 ED 患者没有得到缓解，但拒绝了补充的疼痛药物。患者报告了拒绝进一步使用镇痛药的合理理由，这种拒绝不能作为疼痛缓解的指标。
