title: PAin SoluTions In the Emergency Setting (PASTIES)--patient controlled analgesia versus routine care in emergency department patients with non-traumatic abdominal pain: randomised trial.
abstract: OBJECTIVE
  To determine whether patient controlled analgesia (PCA) is better than routine care in providing effective analgesia for patients presenting to emergency departments with moderate to severe non-traumatic abdominal pain.
  
  
  METHODS
  Pragmatic, multicentre, parallel group, randomised controlled trial
  
  
  METHODS
  Five English hospitals.
  
  
  METHODS
  200 adults (66% (n=130) female), aged 18 to 75 years, who presented to the emergency department requiring intravenous opioid analgesia for the treatment of moderate to severe non-traumatic abdominal pain and were expected to be admitted to hospital for at least 12 hours.
  
  
  METHODS
  Patient controlled analgesia or nurse titrated analgesia (treatment as usual).
  
  
  METHODS
  The primary outcome was total pain experienced over the 12 hour study period, derived by standardised area under the curve (scaled from 0 to 100) of each participant's hourly pain scores, captured using a visual analogue scale. Pre-specified secondary outcomes included total morphine use, percentage of study period in moderate or severe pain, percentage of study period asleep, length of hospital stay, and satisfaction with pain management.
  
  
  RESULTS
  196 participants were included in the primary analyses (99 allocated to PCA and 97 to treatment as usual). Mean total pain experienced was 35.3 (SD 25.8) in the PCA group compared with 47.3 (24.7) in the treatment as usual group. The adjusted between group difference was 6.3 (95% confidence interval 0.7 to 11.9). Participants in the PCA group received significantly more morphine (mean 36.1 (SD 22.4) v 23.6 (13.1) mg; mean difference 12.3 (95% confidence interval 7.2 to 17.4) mg), spent less of the study period in moderate or severe pain (32.6% v 46.9%; mean difference 14.5% (5.6% to 23.5%)), and were more likely to be perfectly or very satisfied with the management of their pain (83% (73/88) v 66% (57/87); adjusted odds ratio 2.56 (1.25 to 5.23)) in comparison with participants in the treatment as usual group.
  
  
  CONCLUSIONS
  Significant reductions in pain can be achieved by PCA compared with treatment as usual in patients presenting to the emergency department with non-traumatic abdominal pain. Trial registration European Clinical Trials Database EudraCT2011-000194-31; Current Controlled Trials ISRCTN25343280.
authors.affiliation: Derriford Hospital, Plymouth PL6 8DH, UK Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Academia), Medical Directorate, Birmingham, UK Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK jasonesmith@nhs.net.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Smith
authors.affiliation: Derriford Hospital, Plymouth PL6 8DH, UK Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Rockett
authors.affiliation: Centre for Biostatistics, Bioinformatics and Biomarkers, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.
authors.forename: Siobhan
authors.initials: S
authors.lastname: Creanor
authors.affiliation: Derriford Hospital, Plymouth PL6 8DH, UK.
authors.forename: Rosalyn
authors.initials: R
authors.lastname: Squire
authors.affiliation: Peninsula Clinical Trials Unit, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Hayward
authors.affiliation: NIHR Research Design Service - South West.
authors.forename: Paul
authors.initials: P
authors.lastname: Ewings
authors.affiliation: NIHR Research Design Service - South West.
authors.forename: Andy
authors.initials: A
authors.lastname: Barton
authors.affiliation: NIHR Research Design Service - South West.
authors.forename: Colin
authors.initials: C
authors.lastname: Pritchard
authors.affiliation: Peninsula Clinical Trials Unit, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Eyre
authors.affiliation: Peninsula Clinical Trials Unit, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Cocking
authors.affiliation: Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Benger
mesh_terms: D015746:Abdominal Pain / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D055815:Young Adult