Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta‐analysis

Sakamoto, Jeffrey Tadashi; Ward, Heather Burrell; Vissoci, João Ricardo Nickenig; Eucker, Stephanie A.

doi:10.1111/acem.13411

Cited by 27 publications

(24 citation statements)

References 84 publications

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“…Importantly, all subgroups reported high rates of willingness to try a variety of pharmacologic and nonpharmacologic interventions, many of which have been shown to improve other pain-related outcomes. 43 For example, patients in the MDI group with high levels of importance for improvements in pain, function, fatigue, and emotion may benefit from more holistic nonpharmacologic interventions like yoga or acupuncture 44,45 therapy. 46 In contrast, patients in the PFI group with high levels of importance for improvements in pain and function may benefit from referrals to services like physical therapy, therapeutic massage, or chiropractic treatment.…”

Section: Discussionmentioning

confidence: 99%

Moving toward patient‐centered care in the emergency department: Patient‐reported expectations, definitions of success, and importance of improvement in pain‐related outcomes

Flynn

Gordee

Kuchibhatla

et al. 2021

Academic Emergency Medicine

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Objectives: Musculoskeletal pain is a common emergency department (ED) presentation, and patient-centered care may improve quality of life, treatment satisfaction, and outcomes. Our objective was to investigate the expectations, definitions of success, and priorities of ED patients with musculoskeletal pain. Methods: We conducted a cross-sectional survey of the demographic, clinical, and psychosocial characteristics of adult ED patients (n = 210) with musculoskeletal pain. Patients completed the Patient-Centered Outcomes Questionnaire to quantify usual, desired, expected, and successful levels of pain and interference with daily activities, fatigue, and emotion from 0 (none) to 100 (worst imaginable). They also reported the importance of improvement in each domain. Cluster analysis identified subgroups by importance ratings. Patients were asked their willingness to try various pharmacologic and nonpharmacologic treatments. Fully completed surveys were analyzed (n = 174). Results: Most patients desired 100% resolution in each domain and defined treatment success as substantial (median = 63.2%-76.5%) reductions but expected only moderate (median = 45%-53.7%) improvements across all domains. Patients with previous pain episodes had similar desired levels but less stringent definitions of success and expectations for improvement. Cluster analysis identified three patient subgroups by importance ratings of each domain: (1) multiple domains important (n = 118) with high importance attached to all four domains, (2) pain and function important (n = 34) with high importance primarily for pain and interference with daily activities, and (3) only pain important (n = 22). Regardless of subgroup, there was a high willingness to use a variety of pharmacologic and nonpharmacologic treatments. Discussion: ED patients with musculoskeletal pain have expectations and goals that include addressing impairments in function, improving quality of life, and reducing pain.

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Section: Discussionmentioning

confidence: 99%

Moving toward patient‐centered care in the emergency department: Patient‐reported expectations, definitions of success, and importance of improvement in pain‐related outcomes

Flynn

Gordee

Kuchibhatla

et al. 2021

Academic Emergency Medicine

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“…Non-pharmacological pain management modalities are often effective in alleviating pain in the ED despite the limited number of studies with small sample sizes. 63…”

Section: What Non-pharmacological Interventions Alleviate Pain In the Ed?mentioning

confidence: 99%

Pain management in the emergency department: a clinical review

Motov

Vlasica²,

Middlebrook³

et al. 2021

Clin Exp Emerg Med

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Pain is one of the most common reasons for patients to visit the emergency department. The ever-growing research on emergency department analgesia has challenged the current practices with respect to the optimal analgesic regimen for acute musculoskeletal pain, safe and judicious opioid prescribing, appropriate utilization of non-opioid therapeutics, and non-pharmacological treatment modalities. This clinical review is set to provide evidence-based answers to these challenging questions.

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“…41 Recognition of gaps in the evidence base and the quality of studies is increasing. 42,43 National Institutes of Health's efforts have focused on better understanding of mechanisms of pain that may lend themselves to therapeutic interventions. 44 Recent guidelines from the Centers for Disease Control and Prevention limit the quantity of medication given.…”

Section: The Requirement In 2005 By the Deficit Reduction Actmentioning

confidence: 99%

Management of Pain in the United States—A Brief History and Implications for the Opioid Epidemic

Bernard

Chelminski

Ives

et al. 2018

Health�Serv�Insights

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Pain management in the United States reflects attitudes to those in pain. Increased numbers of disabled veterans in the 1940s to 1960s led to an increased focus on pain and its treatment. The view of the person in pain has moved back and forth between a physiological construct to an individual with pain where perception may be related to social, emotional, and cultural factors. Conceptually, pain has both a medical basis and a political context, moving between, for example, objective evidence of disability due to pain and subjective concerns of malingering. In the 20th century, pain management became predominately pharmacologic. Perceptions of undertreatment led to increased use of opioids, at first for those with cancer-related pain and then later for noncancer pain without the multidimensional care that was intended. The increased use was related to exaggerated claims in the medical literature and by the pharmaceutical industry, of a lack of addiction in the setting of noncancer pain for these medications—a claim that was subsequently found to be false and deliberatively deceptive; an epidemic of opioid prescribing began in the 1990s. An alarming rise in deaths due to opioids has led to several efforts to decrease use, both in patients with noncancer conditions and in those with cancer and survivors of cancer.

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Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta‐analysis

Abstract: Nonpharmacologic interventions are often effective in reducing pain in the ED. However, most existing studies are small, warranting further investigation into their use for optimizing ED pain management.

Cited by 27 publications

References 84 publications

Moving toward patient‐centered care in the emergency department: Patient‐reported expectations, definitions of success, and importance of improvement in pain‐related outcomes

Moving toward patient‐centered care in the emergency department: Patient‐reported expectations, definitions of success, and importance of improvement in pain‐related outcomes

Pain management in the emergency department: a clinical review

Management of Pain in the United States—A Brief History and Implications for the Opioid Epidemic

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