title: Semiological evaluation of pain according to its origin: a prospective, observational, and national study of current French medical practice.
abstract: OBJECTIVE
  To determine how the origin of acute pain influences its semiological characteristics, and to evaluate the efficacy and safety of two Level 2 analgesic combinations in general practice.
  
  
  METHODS
  This prospective, observational, multicenter study enrolled patients who consulted general practitioners across France for intense pain that lasted ≥7 days and for which the physician prescribed paracetamol-codeine or paracetamol-tramadol. Completed physician (Day 0) and patient (Days 0-3 and Days 4-7) questionnaires provided data on the origin, characteristics, impact, and treatment of the pain, during the 7 days after the initial consultation.
  
  
  METHODS
  Pain intensity (0-10 unidimensional numerical scale), type (SF-MPQ) and impact on quality of life (QoL; SF-12).
  
  
  RESULTS
  Overall, 1003 patient questionnaires were completed for Days 0-3 and 941 for Days 4-7. The origin of pain was most commonly disease or trauma. Mean baseline pain intensity was 7 (SD 1.3; 0-10 numerical rating scale), and was similar regardless of the origin. The time-course of pain differed according to its origin: more than two-thirds of patients with trauma/work accident related pain described it as being constant, whereas 43% of those with disease-related pain described it as recurrent/intermittent. The origin of pain also influenced its QoL impact: trauma/work accident related pain led to functional and/or professional temporary incapacity in 77% and 83% of patients (vs 63% for disease-related pain), while disease-related pain led to a change in mood and/or feeling of anxiety in 79% of patients (vs 47% [trauma] and 58% [work accident related]). Both paracetamol-codeine and paracetamol-tramadol reduced pain intensity by approximately 75% and were well tolerated. Key limitations relate to the observational study design, countered by advantages gained from the 'real life' evaluation of acute pain and its treatment in a general medical practice setting.
  
  
  CONCLUSIONS
  Acute pain should not be understood as a single entity but as multiple entities with specific characteristics related to its underlying origin. Furthermore, our data suggest that, as already demonstrated in clinical trials, Level 2 analgesia provides effective relief of acute pain in 'real life' conditions.
authors.affiliation: Service de Rhumatologie, CHU Dupuytren, Limoges, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bertin
authors.forename: Charles
authors.initials: C
authors.lastname: Taieb
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D003061:Codeine / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014147:Tramadol / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D004338:Drug Combinations; C526278:acetaminophen, codeine drug combination; D000082:Acetaminophen; D014147:Tramadol; D003061:Codeine