Analgesic use and pain in the hospital settings.
OBJECTIVE
The aim of this study was to assess the analgesic treatment and the prevalence of pain in patients treated with analgesics in hospitals.


METHODS
Adult patients treated with analgesics were selected from a sample of 1,675 patients in a cross-sectional study carried out in 15 Catalonian hospitals (Spain). Patient characteristics, type of analgesics, treatment schedules, patients' pain intensity and clinical ward and hospital characteristics were assessed. Adherence to analgesic use guidelines was established according to the principles and recommendations of internationally recognised guidelines for pain management. Pain was determined by asking patients about pain intensity by means of a visual analogue scale (VAS).


RESULTS
Analgesics were prescribed for 1,173 patients (70%; 95% CI: 67.4-72.6), in whom 57% (95% CI: 54.2-59.8) had pain and in whom 30.5% (95% CI: 27.9-33.1) pain intensity was greater than 30 mm. Adherence to analgesic treatment guidelines was judged appropriate in only 26.9% (95% CI: 24.4-29.4%) of all patients. The administered analgesic dose was in the recommended dose range in 42% (95% CI: 54-58) of all analgesics and in 28% (95% CI: 24-32) of opioid analgesics. A minority of patients was treated with a rescue schedule or patient-controlled analgesia (2%; 95% CI: 1.4-2.6). Pain prevalence was higher in those with analgesic treatment that did not adhere to guidelines (63.6%; 95% CI: 60.4-66.8) than in those considered as having appropriate adherence to guidelines (39.3%; 95% CI: 33.8-44.6) (p < 0.001). Adherence to analgesic treatment guidelines was higher in the large hospitals (21%; 95% CI: 18-24) than in medium and small hospitals (13%; 95% CI: 9-16) (p < 0.001).


CONCLUSIONS
Although analgesic use is high in the hospital settings, adherence to the principles and recommendations of pain guidelines is low, and pain is usually common in patients treated with analgesics. These results once again emphasise the need to improve analgesic use and pain management in hospitals.
Vallano
A
A
Fundació Institut Català de Farmacología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. tv@icf.uab.es
Malouf
J
J
Payrulet
P
P
Baños
J E
JE
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D015995:Prevalence; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid