Patient-Reported outcomes of pain care research in the adult emergency department: A scoping review

Wong, Alixandra; Potter, Joseph E.; Brown, Nathan J.; Chu, Kevin; Hughes, James Alexander

doi:10.1016/j.auec.2020.10.003

Cited by 11 publications

(28 citation statements)

References 73 publications

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“…Previous work has reviewed the patient-reported outcomes used in ED pain research 12 . In this scoping review, five areas of patient-reported outcome measurement were identified within the 56 studies included.…”

Section: Discussionmentioning

confidence: 99%

“…The validity of the tool, however, is limited by its validation in patients with acute abdominal pain only 19 . Despite this, the APS-POQ-R is the most promising PROM for measuring patient-reported outcomes of pain care in the adult ED, and comprehensive psychometric testing is required to establish the validity of an English version in the broad spectrum of ED patients with acute pain 12 .…”

Section: Introductionmentioning

confidence: 99%

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An Initial Psychometric Evaluation of the APS-POQ-R in Acute Pain Presenting to the Emergency Department

Hughes

Jones

Potter

et al. 2020

Preprint

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Background: Pain is a common presenting complaint to the emergency department (ED), yet is often undertreated. When assessing the outcomes of pain care in the ED, process measures are commonly reported. Attempts to measure patient reported outcomes existing in current ED literature. However, they are frequently unvalidated and lack standardization. The American Pain Societies, Patient Outcome Questionnaire, Revised edition (APS POQ R) has been identified as the most likely, preexisting tool to be useful in the acute pain in the ED. However, this requires feasibility and construct validation before use. Objective: To assess the feasibility and construct validity of the APS POQ R in patients presenting to the adult emergency department with acute pain. Methods: This study is an initial psychometric evaluation of the constructs contained within the APS POQ R in adult patients presenting with moderate to severe acute pain to a large urban ED. The study is guided by the methods described in the initial development of the instrument. Results: Two hundred adult patients were recruited and completed the APS POQ R. The APS POQ R demonstrated content validity in patients presenting with acute pain. Exploratory factor analysis demonstrated five subgroups. The tool demonstrated discriminatory ability based on patient urgency, and subscale measurement was associated with patient satisfaction with care. Conclusions: The APS POQ R has demonstrable construct validity in adult patients presenting with acute pain to the ED. Further psychometric analysis across multiple EDs is required before the APS POQ R can be recommended as a validated PROM for ED patients in pain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An Initial Psychometric Evaluation of the APS-POQ-R in Acute Pain Presenting to the Emergency Department

Hughes

Jones

Potter

et al. 2020

Preprint

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“…Few studies have directly investigated this assumption or explored patient experiences of pain management in the ED. Studies that have investigated patient‐reported outcomes of pain care in the ED have typically relied on patient satisfaction or satisfaction with pain care as the outcome (Wong et al., 2020). There has been limited use of broader patient experience measures as an outcome of pain care in the ED (Mandel et al., 2019).…”

Section: Introductionmentioning

confidence: 99%

Factors associated with the experience of patients presenting in pain to the emergency department

Hughes

Alexander

Spencer

et al. 2021

Journal of Clinical Nursing

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Aims and Objectives This study aims to examine the association between person, environment, health and illness factors, pain care and the patient experience in the emergency department, guided by symptom management theory. Background Current outcome measures of pain care in the emergency department focus on process measures such as the time taken to deliver analgesic medication. Patient‐reported outcomes of pain care are rare in emergency department literature and predominantly focus on patient satisfaction. Measuring overall patient experience is common, with extensive surveys undertaken in the United Kingdom, United States of America and Australia; however, these are not used as an outcome of pain care. Design Prospective cohort study. Methods One hundred and ninety patients arriving at a large, inner‐city adults‐only emergency department in moderate to severe pain were recruited to answer a modified version of the emergency department patient experience of care survey. Results Fifteen factors were identified as influencing the patient experience of care when presenting in pain. These influences of patient experience included the emergency department environment, time to first analgesic medication and the provision of analgesic medication. Conclusions In addition to pain care factors, there is a significant association between the emergency department environment—especially workload, throughput and patient placement—and the experience of patients who present in pain to the emergency department. Relevance to Clinical Practice This study demonstrated an association between time to first analgesic medication and the patient experience of care. Providing timely care, including pain care, in emergency departments is difficult, but necessary to improve the patient experience of care.

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“…A recent systematic review showed that the addition of opioids was no more effective than nonsteroidal anti‐inflammatory drugs (NSAIDs) or acetaminophen alone, but was associated with more adverse events (AEs) in musculoskeletal injuries 3 . However, opioids are indispensable for acute severe pain, 4,5 and early pain relief is of utmost importance to emergency patients 6 . Titration of opioids has been shown to be highly effective for pain relief, 5 but adherence to published protocols is often poor and needs to be monitored to optimize pain management 7 .…”

Section: Introductionmentioning

confidence: 99%

“…3 However, opioids are indispensable for acute severe pain, 4,5 and early pain relief is of utmost importance to emergency patients. 6 Titration of opioids has been shown to be highly effective for pain relief, 5 but adherence to published protocols is often poor and needs to be monitored to optimize pain management. 7 Opioids have significant disadvantages, such as frequent and expected adverse effects (nausea and vomiting), a narrow therapeutic margin limiting their use due to respiratory depression, and finally a significant potential for misuse and overdose.…”

Section: Introductionmentioning

confidence: 99%

Intravenous acetaminophen does not reduce morphine use for pain relief in emergency department patients: A multicenter, randomized, double‐blind, placebo‐controlled trial

Minotti

Mansella

Sieber

et al. 2022

Academic Emergency Medicine

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Background: Pain is one of the main reasons to present to emergency departments (EDs). Opioids are indispensable for acute pain management but are associated with side effects, misuse, and dependence. The aim of this study was to test whether a single dose of intravenous (IV) acetaminophen (paracetamol) can reduce the use of morphine for pain relief and/or morphine-related adverse events (AEs).Methods: ED patients >18 years with acute pain (i.e., Numeric Rating Scale [NRS] > 4) were screened for eligibility. Patients with analgesia in the past 6 h, chronic pain, or clinical instability were excluded. Patients were randomized in a 1:1 ratio to receive either morphine 0.1 mg/kg and 1 g acetaminophen IV or morphine 0.1 mg/kg and placebo IV. The intervention was double-blinded. Additional morphine 0.05 mg/kg IV was administered every 15 minutes until pain relief (defined as NRS < 4) and whether the pain recurred. The primary outcome was the mean morphine dose for pain relief.Secondary outcomes were the total amount of morphine given, time to achieve pain relief, and AEs.Results: A total of 220 patients were randomized and 202 evaluated for the primary outcome. The mean morphine dose for pain relief was similar in both groups (acetaminophen 0.15 mg ± 0.07 mg/kg, placebo 0.16 ± 0.07 mg/kg). There were no differences in the total amount of morphine given (acetaminophen 0.19 ± 0.09 mg/kg, placebo 0.19 ± 0.1 mg/kg), the time to achieve pain relief (acetaminophen 30 min [95% CI 17-31 min], placebo 30 min [95% CI 30-35 min]), and the frequency of AEs (overall 27.4%). Time to pain recurrence did not differ significantly between the groups (hazard ratio 1.23 [0.76-1.98], p = 0.40). Conclusions:In ED patients, acetaminophen had no additional effect on pain control or morphine-sparing effect at the time of first morphine administration. Titrated morphine with the algorithm used was highly effective, with 80% of all patients reporting pain relief within 60 min of starting therapy.

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Patient-Reported outcomes of pain care research in the adult emergency department: A scoping review

Cited by 11 publications

References 73 publications

An Initial Psychometric Evaluation of the APS-POQ-R in Acute Pain Presenting to the Emergency Department

An Initial Psychometric Evaluation of the APS-POQ-R in Acute Pain Presenting to the Emergency Department

Factors associated with the experience of patients presenting in pain to the emergency department

Intravenous acetaminophen does not reduce morphine use for pain relief in emergency department patients: A multicenter, randomized, double‐blind, placebo‐controlled trial

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