title: Patient anxiety may influence the efficacy of ED pain management.
abstract: OBJECTIVE
  The aim of this study was to evaluate the incidence of anxiety and rates of anxiety treatment in emergency department (ED) patients presenting with pain-related complaints.
  
  
  METHODS
  We prospectively evaluated patients in an urban academic tertiary care hospital ED from 2000 through 2010. We enrolled a convenience sample of adult patients presenting with pain and recorded patient complaint, medication administration, satisfaction, and pain and anxiety scores throughout their stay. We stratified patients into 4 different groups according to anxiety score at presentation (0, none; 1-4, mild; 5-7, moderate; 8-10, severe).
  
  
  RESULTS
  We enrolled 10 664 ED patients presenting with pain-related complaints. Patients reporting anxiety were as follows: 25.7%, none; 26.1%, mild; 23.7%, moderate; and 24.5%, severe. Although 48% of patients described moderate to severe anxiety at ED presentation and 60% were willing to take a medication for anxiety, only 1% received anxiety treatment. Thirty-five percent of patients still reported moderate/severe anxiety at discharge. Severe anxiety at ED presentation was associated with increased demand for pain medication (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.10-1.79) and anxiety medication (OR, 4.34; 95% CI, 3.68-5.11) during the ED stay and decreased satisfaction with the treatment of pain (β coefficient = -0.328; P < .001). After adjusting for age, sex, and presentation pain scores, patients who reported severe anxiety were more likely to receive an analgesic (OR, 1.33; 95% CI, 1.19-1.50) and an opioid (OR, 1.25; 95% CI, 1.11-1.41) during the ED stay.
  
  
  CONCLUSIONS
  Anxiety may be underrecognized and undertreated in patients presenting with pain-related complaints. Patients reporting severe anxiety were less likely to report satisfaction with the treatment of their pain, despite higher rates of analgesic administration.
authors.affiliation: University of Utah, Salt Lake City, UT 84132, USA. Philip.craven@hsc.utah.edu
authors.forename: Philip
authors.initials: P
authors.lastname: Craven
authors.forename: Orhan
authors.initials: O
authors.lastname: Cinar
authors.forename: Troy
authors.initials: T
authors.lastname: Madsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D001007:Anxiety / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D059408:Pain Management / Q000523:psychology*; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D057566:Self Report; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics