title: Exploratory cross-sectional study of factors associated with pre-hospital management of pain.
abstract: OBJECTIVE
  Improving pain management is important in pre-hospital settings. We aimed to investigate how pain was managed in pre-hospital suspected acute myocardial infarction (AMI) or fracture and how this could be improved.
  
  
  METHODS
  We conducted a cross-sectional study in Lincolnshire using recorded suspected AMI and fracture between April 2005 and March 2006. Outcomes included pain assessment, improvement in pain scores and administration of Entonox, opiates or GTN (in AMI).
  
  
  RESULTS
  We accessed 3654 patients with suspected AMI or fracture. Pain was assessed in over three quarters of patients but analgesics administered in under two-fifths. Assessment was more likely in patients with suspected AMI (OR 2.05, 95% CI [1.70, 2.47]), and who were alert (OR 3.55, 95% CI [2.32, 5.43]). Entonox was less likely to be administered for suspected AMI (OR 0.11, 95% CI [0.087, 0.15]) or by paramedic crews (OR 0.56, 95% CI [0.45, 0.68]) but more likely to be given when pain had been assessed (OR 3.54, 95% CI [2.77, 4.52]). Opiates were more likely to be prescribed for suspected AMI (OR 1.30, 95% CI [1.07, 1.57]), in alert patients (OR 1.35, 95% CI [0.71, 2.56]) assessed for pain (OR 2.20, 95% CI [1.73, 2.80]) by paramedic crews.
  
  
  CONCLUSIONS
  This exploratory study showed shortfalls in assessment and treatment of pain, but also demonstrated that assessment of pain was associated with more effective treatment. Further research is needed to understand barriers to pre-hospital pain management and investigate mechanisms to overcome these.
authors: Faculty of Health, Life and Social Sciences, University of Lincoln, Lincoln, UK. nsiriwardena@lincoln.ac.uk
authors: A Niroshan
authors: AN
authors: Siriwardena
authors: Deborah
authors: D
authors: Shaw
authors: George
authors: G
authors: Bouliotis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services; D004739:England; D005260:Female; D050723:Fractures, Bone / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000700:Analgesics