Approaching acute pain in emergency settings; European Society for Emergency Medicine (EUSEM) guidelines—part 2: management and recommendations

Hachimi-Idrissi, Saı̈d; Dobias, Viliam; Hautz, Wolf E.; Leach, Robert; Sauter, Thomas; Sforzi, Idanna; Coffey, Frank

doi:10.1007/s11739-020-02411-2

Cited by 25 publications

(36 citation statements)

References 105 publications

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“…Pain is one of the most common problems leading to emergency department (ED) presentation. However, pain management in the ED remains challenging [ 1 – 3 ]. Many barriers to effective pain management in the ED have been reported, and include the individual pain level of the patient (e.g., the highly subjective experience of pain) as an important influencing factor [ 1 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Many barriers to effective pain management in the ED have been reported, and include the individual pain level of the patient (e.g., the highly subjective experience of pain) as an important influencing factor [ 1 , 4 ]. A wide range of pharmacological therapies including both opioid and non-opioid medications exist and are broadly applied in the ED via different routes of application, yet there are specific side effects and contraindications to consider [ 3 ]. Furthermore, EDs are a major source of opioid prescription and thus, in some countries, contribute to the rising opioid dependency crisis [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Virtual Reality for Pain Relief in the Emergency Room (VIPER) – a prospective, interventional feasibility study

et al. 2022

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Background Pain is one of the most common, yet challenging problems leading to emergency department (ED) presentation, despite the availability of a wide range of pharmacological therapies. Virtual reality (VR) simulations are well studied in a wide variety of clinical settings, including acute and chronic pain management, as well as anxiety disorders. However, studies in the busy environment of an adult ED are scarce. The aim of this study is to explore the feasibility and effectiveness of a VR simulation for pain and anxiety control in a convenience sample of adult ED patients presenting with traumatic and non-traumatic pain triaged 2–5 (i.e., urgent to non-urgent) with a pain rating of ≥ 3 on a numeric rating scale (NRS 0–10). Methods Prospective within-subject, repeated measures interventional feasibility pilot study at a Swiss University ED. The intervention consisted of a virtual reality simulation in addition to usual care. Pain and anxiety levels were measured using a verbally administered numeric rating scale (NRS) before and after the intervention. Information on patient experience was collected using established rating scales. Results Fifty-two patients were enrolled. The most common pain localisations were extremities (n = 15, 28.8%) and abdomen (n = 12, 23.1%). About one third of patients presented with trauma-associated pain (n = 16, 30.8%). Duration of pain was mainly acute (< 24 h) (n = 16, 30.8%) or subacute (> 24 h) (n = 32, 61.5%). The majority of patients were triage category 3, i.e. semi-urgent (n = 48, 92.3%). Significant reduction in pain (NRS median pre-VR simulation 4.5 (IQR 3–7) vs. median post-VR simulation 3 (IQR 2–5), p < 0.001), and anxiety levels (NRS median pre-VR simulation 4 (IQR 2–5) vs. median post-VR simulation 2 (IQR 0–3), p < 0.001) was achieved, yielding moderate to large effect sizes (Cohen’s d estimate for pain reduction = 0.59 (95% CI 0.19—0.98), for anxiety level on NRS = 0.75 (95% CI 0.34—1.15). With medium immersion and good tolerability of the VR simulation, user satisfaction was high. Conclusions Virtual reality analgesia for pain and anxiety reduction in the busy setting of an ED is feasible, effective, with high user satisfaction. Further randomized controlled studies are needed to better characterize its impact on pain perception and resource utilization.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Virtual Reality for Pain Relief in the Emergency Room (VIPER) – a prospective, interventional feasibility study

et al. 2022

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“…An inadequate assessment could cause underestimation of the patient's pain, leading to inappropriate pain management ( 8 , 16 ). According to governing organizations on pain, and guidelines, patients have the right to be involved in all aspects of their pain management ( 2 , 6 , 11 , 17 ).…”

Section: Introductionmentioning

confidence: 99%

“…Despite different guidelines, patients’ acute pain has not always been properly treated ( 24 ). Inadequate pain management in the ED setting is still a challenge and there have been marginal reports of how the pain management process can be improved in EDs ( 11 , 22 , 25 ). This manuscript provides new improvement initiatives to the emergency patients globally with implications for translation of new acute pain assessment knowledge into practice.…”

Section: Introductionmentioning

confidence: 99%

Acute Pain Assessment Inadequacy in the Emergency Department: Patients’ Perspective

Hämäläinen

Kvist

Kankkunen

2022

Journal of Patient Experience

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For many patients, acute pain is a common cause to seek treatment in an Emergency Department (ED). An inadequate assessment could cause inappropriate pain management. The aim of this study was to describe and explain patients’ perceptions of acute pain assessment in the Emergency Department. The data were collected from ED patients (n = 114). Patients reported that nurses were asking about intensity of pain at rest, but only 52% during movement. According to the patients, the most common tools to assess acute pain were the verbal rating scale (VRS; 54% of patients), numerical rating scale (NRS; 28% of patients), and visual analogue scale (VAS; 9.7% of patients). Over twenty per cent of patients stated that ED nurses did not ask about the intensity of pain after analgesic administration. Twenty-four per cent of the patients were not pleased with nursing pain assessment in the ED. The assessment of acute pain is still inadequate in the ED. Therefore, ED nurses need to be more attentive to systematic acute pain management of patients in the ED.

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“…The objective behind these videos would be 'to walk the practitioner through' a specific procedure that may be required for a patient, but that the doctor may not have had any training in. All these resources are available on a unique webpage so the colleagues can easily find them [2] We also highlighted our guidelines for acute pain management in emergency situations [3,4].…”

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confidence: 99%

The role of the European Society for Emergency Medicine in wartime

Leach

Kaur²,

Laribi

et al. 2022

European Journal of Emergency Medicine

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Approaching acute pain in emergency settings; European Society for Emergency Medicine (EUSEM) guidelines—part 2: management and recommendations

Cited by 25 publications

References 105 publications

Virtual Reality for Pain Relief in the Emergency Room (VIPER) – a prospective, interventional feasibility study

Virtual Reality for Pain Relief in the Emergency Room (VIPER) – a prospective, interventional feasibility study

Acute Pain Assessment Inadequacy in the Emergency Department: Patients’ Perspective

The role of the European Society for Emergency Medicine in wartime

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