title: Pain management in the emergency chain: the use and effectiveness of pain management in patients with acute musculoskeletal pain.
abstract: OBJECTIVE
  While acute musculoskeletal pain is a frequent complaint in emergency care, its management is often neglected, placing patients at risk for insufficient pain relief. Our aim is to investigate how often pain management is provided in the prehospital phase and emergency department (ED) and how this affects pain relief. A secondary goal is to identify prognostic factors for clinically relevant pain relief.
  
  
  METHODS
  This prospective study (PROTACT) includes 697 patients admitted to ED with musculoskeletal extremity injury. Data regarding pain, injury, and pain management were collected using questionnaires and registries.
  
  
  RESULTS
  Although 39.9% of the patients used analgesics in the prehospital phase, most patients arrived at the ED with severe pain. Despite the high pain prevalence in the ED, only 35.7% of the patients received analgesics and 12.5% received adequate analgesic pain management. More than two-third of the patients still had moderate to severe pain at discharge. Clinically relevant pain relief was achieved in only 19.7% of the patients. Pain relief in the ED was higher in patients who received analgesics compared with those who did not. Besides analgesics, the type of injury and pain intensity on admission were associated with pain relief.
  
  
  CONCLUSIONS
  There is still room for improvement of musculoskeletal pain management in the chain of emergency care. A high percentage of patients were discharged with unacceptable pain levels. The use of multimodal pain management or the implementation of a pain management protocol might be useful methods to optimize pain relief. Additional research in these areas is needed.
authors.affiliation: Health Technology & Services Research, MIRA institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede.
authors.forename: Jorien G J
authors.initials: JG
authors.lastname: Pierik
authors.affiliation: Health Technology & Services Research, MIRA institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: IJzerman
authors.affiliation: Emergency Department, Admiraal De Ruyter Ziekenhuis, Goes.
authors.forename: Menno I
authors.initials: MI
authors.lastname: Gaakeer
authors.affiliation: Regional Emergency Healthcare Network, Radboud University Nijmegen, Nijmegen.|Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen.
authors.forename: Sivera A
authors.initials: SA
authors.lastname: Berben
authors.affiliation: Ambulance Oost, Hengelo.|Anesthesiology, Ziekenhuisgroep Twente, Almelo.
authors.forename: Fred L
authors.initials: FL
authors.lastname: van Eenennaam
authors.affiliation: Emergency Department and Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Arie B
authors.initials: AB
authors.lastname: van Vugt
authors.affiliation: Health Technology & Services Research, MIRA institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede.
authors.forename: Carine J M
authors.initials: CJ
authors.lastname: Doggen
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods*; D011446:Prospective Studies
chemical_list: D000700:Analgesics
keywords: Acute Musculoskeletal Pain; Ambulance; Analgesics; Chain of Emergency Care; Clinically Relevant Pain Relief; Emergency Department