Factors associated with self-reported pain scores among ED patients

Marco, Catherine A.; Nagel, Jacqueline; Klink, Ellen; Baehren, David F.

doi:10.1016/j.ajem.2010.12.015

Cited by 39 publications

(21 citation statements)

References 39 publications

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“…However, our finding that the distribution of the pain scale is not Gaussian but left shifted is in accordance with other studies [18,19]. The rated pain values are in line with previous research [20,21]. However, patients seeking treatment for abdominal pain or orthopedic complaints rated a significantly higher median pain score compared with patients with chest pain, regardless of scale.…”

Section: Discussionsupporting

confidence: 95%

Pain rating in the ED—a comparison between 2 scales in a Swedish hospital

Göransson

Heilborn

Selberg

et al. 2015

The American Journal of Emergency Medicine

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Section: Discussionsupporting

confidence: 95%

Pain rating in the ED—a comparison between 2 scales in a Swedish hospital

Göransson

Heilborn

Selberg

et al. 2015

The American Journal of Emergency Medicine

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“…Past studies have found that patients who had severe pain were significantly younger than those without it. [31][32][33] Other researchers have also found that patients undergoing orthopedic surgery related higher pain scores. Orthopedic patients have reported more pain and nausea at 72 hours than at any other earlier time period and required a continued need for nursing contact and support.…”

Section: Discussionmentioning

confidence: 94%

The Relationship of Pain and Nausea in Postoperative Patients for 1 Week After Ambulatory Surgery

Odom-Forren

Rayens

Gokun

et al. 2015

The Clinical Journal of Pain

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Younger patients and those receiving orthopedic procedures may be at greatest risk for postoperative pain. Patients with high pain reported a significantly greater degree of nausea on DOS through the first 5 days postdischarge. As the majority of surgeries are now conducted in the ambulatory setting, it is imperative that we determine pain management regimens and patient education practices that will allow for a more comfortable recovery for our patients.

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“…There was also rich use of emotional terms in describing the experience of maximum pain, even where specific injuries such as fractures were described for own worst pain: for instance, a participant who identified a dislocated shoulder, rated 8/10, as his or her worst pain described the experience of pain of 10/10 as "excruciating". Fractures were highly represented among causes of maximum pain, as was childbirth, reflecting beliefs about expected levels of pain according to the tissue damage or stress [38].…”

Section: Discussionmentioning

confidence: 99%

How do medical students use and understand pain rating scales?

Zalmay

Williams

2017

Scandinavian Journal of Pain

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AbstractBackground and aimsPain is a multidimensional experience that is difficult to describe and to assess. To scale current pain, assessment refers to a maximum level of pain, but little is known about this process. Further, clinicians tend to underestimate patients’ pain, with or without patients’ own reports, and to underestimate to a greater extent with more clinical experience, possibly due to recalibration of a personal pain scale with increasing exposure to severe pain. We sought to determine how medical students rated pain in early years of clinical exposure, and in relation to experience of their own and others’ worst pains.Methods An online survey sampled medical students’ rating and description of their own worst pain and of that witnessed in another; also what would cause the maximum level of pain and what behaviours characterised it. Last, they indicated their preference among pain scales.Results Thirty-six medical students provided responses, the majority in their first six months of clinical exposure. Students’ own worst pain was rated a mean of 6.7/10 (s.d. 1.6) on a numerical scale; causes were diverse but with many bone fractures. Mean worst pain observed in another was rated 8.6/10 (s.d. 1.4); causes included fractures, gallstones, and sickle cell crises. Another’s worst pain was significantly higher (mean 9.4, s.d. 0.8 vs mean 8.0 s.d. 1.4) when rated after the student’s own pain than before it (presentation order randomised).We found no effect of clinical exposure on estimation of worst pain in another person, nor was there a personal tendency to rate pain using more or less extreme values. Students expected pain of 10/10 to be presented with many verbal, facial and whole body behaviours, and signs of physiological stress. Collectively, behavioural descriptions were rich and varied, but with many incompatibilities: for instance, between ‘writhing’ and ‘rigidity’ expected in the person with extreme pain. Most students preferred the numerical rating scale over visual analogue and verbal scales.ConclusionsThe study requires replication, particularly for clinical experience, where we found no significant difference in estimation of another’s pain over the first three years of medical students’ clinical exposure, but the comparison was underpowered. Despite no systematic individual difference in using pain ratings, there was a marked effect of rating another’s worst pain higher when the rater had previously rated his/her own worst pain. This suggests anchoring estimate of another’s pain in personal pain experience, and a possible way to mitigate clinicians’ underestimation of patients’ pain.Medical students’ recognition of the importance of facial expression in indicating another’s pain severity was encouraging, but most students anticipated only a narrow range of behaviours associated with extreme pain, thereby excluding other authentic behaviours.ImplicationsMany clinical guidelines mandate regular pain assessment for hospital inpatients, and encourage routine assessment in community and outpatient settings, in order to decide on and monitor treatment. Replication and elaboration of this study could extend our understanding of how clinicians interpret pain scales completed by patients, and how they estimate patients’ pain.

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Factors associated with self-reported pain scores among ED patients

Cited by 39 publications

References 39 publications

Pain rating in the ED—a comparison between 2 scales in a Swedish hospital

Pain rating in the ED—a comparison between 2 scales in a Swedish hospital

The Relationship of Pain and Nausea in Postoperative Patients for 1 Week After Ambulatory Surgery

How do medical students use and understand pain rating scales?

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