Emergency care providers' perspectives of acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: A qualitative study

Patient, family member, and ambulance staff experiences of prehospital acute pain management in adults: A systematic review and meta‐synthesis

“…Pain treatment decisions included consideration of both pharmacological and nonpharmacological interventions and ambulance clinicians were eager to stress the importance of nonpharmacological techniques. 28 , 38 , 45 …”

“…There were also considerations regarding a patient's right to pain medication, particularly for suspected substance misuse and potential litigation for not administering pain medication. 28 , 45 …”

“…Several contextual factors were identified that influence pain management, such as distance to hospital, 45 , 49 potential hospital staff perceptions of pain management, 45 extrication considerations, 49 environmental factors, 47 family, friend and public bystander interactions (calm and relaxed vs. agitated or abusive), 45 organizational factors, 45 and pain education and knowledge: “ The participants also identified that one of the principal reasons they administer analgesia is to assist in getting a patient out of a situation and to aid their removal to hospital, as opposed to purely because they are in pain .” Jones and Machen 42 [researcher quotation].…”

“…There was consideration around pain care continuity and collaboration between the prehospital and emergency department setting, with clear communication at handover being highlighted as key to improving the patient care pathway. 38 , 47 Discordance was identified where expectations and management of patients lacked consensus between settings: “ The data suggest a dissociation between prehospital and ED [emergency department] pain care, with hospital staff apparently lacking an understanding of the prehospital environment and scopes of practice… Some hospital staff disapprove or criticise prehospital pain management .” Lourens et al 45 [researcher quotation].…”

“…There were barriers and resistance to the use of validated pain assessment scales, particularly where communication and language difficulties were present 38,42,33 or where diffuse, nonspecific symptoms were reported 33 . Resistance to the use of pain assessment scales was identified in the context of trauma, where injury treatment was deemed a greater priority than pain assessment 27 and in cases of perceived pain score inaccuracy due to suspected dishonesty or overestimation of pain 45 . There was also variation in pain score understanding reported by patients, with some finding the verbal numeric scale (0–10) confusing, perhaps due to the nature of the pain scale or its poor delivery by some ambulance clinicians (that may warrant re‐training): “ The ambulance man, he sort of asked me ‘is it [pain] a two or is it a three’ and I was thinking ‘is this out of what?’ ” Iqbal et al 38 [participant quotation].…”