Lack of influence of patient self-report of pain intensity on administration of opioids for suspected long-bone fractures.
The purpose of the present study was to prospectively investigate the extent to which emergency providers base their decisions about pain management of suspected long-bone fracture on patient's self-reported pain intensity. Of 100 long-bone fracture patients presenting to 2 inner-city emergency departments, 69% received opioids as compared to 30% of 110 patients without long-bone fracture (RR = 2.3; 95% CI 1.6 to 3.1). After stratification by pain ratings on a validated self-reported numerical rating scale, fracture patients remained twice as likely to receive opioids as those without fracture (RR = 2.0; 95% CI 1.5 to 2.7). Similarly, multivariate adjustment for self-reported pain intensity had little effect on the observed association (RR = 2.1; 95% CI 1.6 to 2.8). We conclude that emergency providers do not primarily base their decisions about pain management of suspected long-bone fractures on patient self-reporting of pain intensity.


CONCLUSIONS
This article addresses the question of the role of self-reported pain intensity rating on the treatment of suspected fractures. The findings indicate that self-reported pain is not used as the most important measure of pain as recommended by expert panels. We speculate this may contribute to oligoanalgesia in the Emergency Department.
Bijur
Polly E
PE
Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA. bijur@aecom.yu.edu
Bérard
Anick
A
Esses
David
D
Nestor
Jordan
J
Schechter
Clyde
C
Gallagher
E John
EJ
D000698:Analgesia / Q000523:psychology / Q000706:statistics & numerical data / Q000639:trends; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data / Q000639:trends; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods / Q000523:psychology* / Q000639:trends; D010817:Physician-Patient Relations; D011446:Prospective Studies; D012647:Self-Assessment
D000701:Analgesics, Opioid