Analgesic Modality Used for Trauma, Abdominal Pain in ED May Not Affect Persistent Pain

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Patients presenting with trauma vs abdominal pain were found to be more likely to report persistent pain at 6 months.
Patients presenting with trauma vs abdominal pain were found to be more likely to report persistent pain at 6 months.

The analgesic modality used in patients presenting to the emergency department with trauma, including abdominal pain, may not affect the presence of persistent pain at 6 months, according to a study published in Anaesthesia.

A total of 141 patients who presented to the emergency department with nontraumatic abdominal pain or a traumatic injury and who required in-hospital intravenous opioid analgesia were enrolled in this study. Participants completed the quality of life EQ5D assessment, the Brief Pain Inventory, and the Hospital Anxiety and Depression scale questionnaire 6 months following hospital admission. The presence of persistent pain at 6 months was the study's primary outcome measure. A mean pain score ≥4 or worst pain score ≥8 at 6 months indicated significant persistent pain.

Patients with trauma vs abdominal pain were found to be more likely to report persistent pain at 6 months (70% vs 31%, respectively; 95% CI, 24%-54%; P <.001). Quality of life assessed with the EQ5D was lower in patients with persistent pain, regardless of admission type (abdominal pain vs traumatic injury). Additionally, participants who reported persistent pain had worse overall health and higher anxiety and depression (P <.05).

Analgesic modality (ie, patient-controlled analgesia vs usual treatment) was not found to affect the incidence of persistent pain at 6 months in patients presenting with abdominal pain (26% vs 41%, respectively; 95% CI for difference, −8; 39%; P =.183). Acute pain scores reported at admission were found to be higher in patients who reported persistent pain at the 6-month follow-up (95% CI, 0.7-23.6; P =.039). In patients who presented with traumatic pain, 71% of those who received patient-controlled analgesia vs 69% of those treated with usual care reported persistent pain (95% CI, −30; -24%; P =.830).

A main limitation of this study is the reliance on self-reports for the assessment of pain.

“Participants presenting with pain due to traumatic injuries frequently [have] persistent pain, but there appears to be a lack of correlation between the severity of acute pain and persistent pain prevalence in this group,” noted the study authors.

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Reference

Rockett M, Creanor S, Squire R, et al. The impact of emergency department patient-controlled analgesia (PCA) on the incidence of chronic pain following trauma and non-traumatic abdominal pain [published online October 27, 2018]. Anaesthesia. doi: 10.1111/anae.14476

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