Six Trajectories Identified for Acute Pain Post-Emergency Department Visit

Six distinct patterns of trajectories for the resolution of acute pain after discharge from the emergency department (ED) were identified in a study published in the Annals of Emergency Medicine.

The study included participants admitted to the ED with an acute pain condition (ie, lasting ≤2 weeks) who were discharged with an opioid prescription (n=372). Participants were asked to complete a diary over a 14-day period in which they were asked to report pain intensity on a 0 to 10 numeric rating scale and pain medication use.

The researchers identified 6 distinct patterns of pain trajectory following an ED visit. One pain trajectory was found to start with severe levels of pain that were maintained (12.6% of patients). Another trajectory started with severe pain and progressed to moderate pain intensity at 14 days (26.3%). The third trajectory started with severe pain and decreased to mild pain (21.7%). The fourth started with severe pain and ended with no pain (13.8%). The fifth started with moderate pain that decreased to mild pain (15.9%). The sixth started with mild pain that ended with no pain at all (9.7%).

Age was found to affect pain trajectories, with patients reporting severe to moderate pain trajectory being significantly older than patients in the mild to no pain trajectory. Musculoskeletal pain was found to be associated to a greater extent with the severe to moderate and severe to mild trajectories vs the other 4 trajectories. Fracture pain was found to be associated with the severe to moderate trajectory, and renal colic pain with the mild to no-pain trajectory.

During follow-up, 82% of participants used opioids, 72% used acetaminophen, and 45% used nonsteroidal anti-inflammatory drugs. Participants with a severe to severe trajectory were found to consume more opioids compared with participants with different trajectories.

“These trajectories are more informative than simple linear models and could be useful in future research for the management of acute pain and for the early identification of patients at risk [for] chronic pain,” the researchers noted.

Reference

Daoust R, Paquet J, Cournoyer A, et al. Acute pain resolution after an emergency department visit: a 14-day trajectory analysis. [published online February 20, 2019]. Ann Emerg Med. doi:10.1016/j.annemergmed.2019.01.019