The effect of standard care, ibuprofen, and music on pain relief and patient satisfaction in adults with musculoskeletal trauma.

OBJECTIVE: The purposes of this study were to determine the most effective nursing intervention to decrease pain for patients with minor musculoskeletal trauma and moderate pain at triage and to examine patient satisfaction. METHODS: Patients were assigned to 1 of 3 intervention groups: (1) standard care (ice, elevation, and immobilization); (2) standard care and ibuprofen; or (3) standard care and music distraction. Patients were monitored for pain ratings for 60 minutes. Patients who sustained minor musculoskeletal trauma within the past 24 hours and presented with pain ratings of 4 or greater were included. Two patient satisfaction questions were asked upon discharge from the emergency department. RESULTS: Seventy-seven patients met the inclusion criteria. No differences in pain ratings between groups were demonstrated. A statistically significant reduction in pain for all patients occurred at 30 minutes (F = 16.18, P <.01) and was maintained at 60 minutes. However, 70% of patients continued to report pain ratings of 4 or greater (on a scale of 1 to 10) at 60 minutes. The reduction in pain was not found to be clinically significant.Eighty-four percent of patients stated that they were more satisfied with their overall care in the emergency department because of the immediate attention to pain relief they received at triage. No differences in satisfaction existed between treatment groups, although patients who reported higher pain ratings expressed statistically significant lower satisfaction with pain management scores (F = 9.375, P =.003). CONCLUSION: None of the therapies-standard care (ice, elevation, immobilization), standard care with ibuprofen, or standard care with music distraction-provided clinically significant pain relief to patients who had minor musculoskeletal trauma (ie, sprains and fractures) and moderate pain at triage. Interestingly, satisfaction scores were sometimes positive, even when pain was not relieved.

Emergency nurses' knowledge of pain management principles.

INTRODUCTION: The purpose of this study was to determine areas of emergency nurses' knowledge deficit regarding pain management, and to identify barriers to pain management as perceived by emergency nurses. METHODS: Data were collected anonymously in a mail survey using a 52-item knowledge questionnaire addressing pain management principles and asking emergency nurses (Illinois Emergency Nurses Association members) to rate various barriers as to how often they affect their practice. Questionnaires were mailed to all Illinois ENA members (n = 1000). RESULTS: Three hundred five emergency nurses' questionnaires were returned. A significant deficit existed on 2 domains of knowledge: understanding of the terms "addiction," "tolerance," and "dependence"; and knowledge of various pharmacologic analgesic principles. Nurses with a master's degree or higher, or those who attended a 1-day seminar on pain management, achieved statistically significantly higher scores. The 2 barriers identified by emergency nurses as the most common were the inability to administer medication until a diagnosis is made (53%), and inadequate assessment of pain and pain relief (48%) (the percentage indicates how often the emergency nurses believed the barrier was present in their practice). DISCUSSION: The data indicate that emergency nurses may not have a good understanding of the management of pain with drugs, or of such issues as risk of addiction.

A prospective study of ED pain management practices and the patient's perspective.

OBJECTIVE: This study was conducted to describe the prevalence of pain in the emergency department and to identify factors that may contribute to its treatment. METHODS: Interviews were conducted with 203 patients who entered the emergency department during the study period. Patients were interviewed regarding various aspects of their pain. Medical records were reviewed to determine what treatments were provided. RESULTS: One hundred sixty of the 203 patients came to the emergency department with a chief complaint related to pain, indicating a prevalence rate of 78%. Approximately 58% of all patients received either medication or an intervention. An average of 74 minutes elapsed from the time of arrival in the emergency department to the time of treatment with pharmacologic agents. Various independent variables were examined to determine their ability to predict the treatment of pain. Chest pain was most often treated with medication, and abdominal pain was least often treated with medication. Despite high pain ratings, only 15% of the sample received an opioid. DISCUSSION: This study revealed a very high prevalence of pain among patients in the emergency department and showed that, overall, pain was poorly treated. The findings suggest that chest pain is the only type of pain routinely relieved in the emergency department. An anecdotal finding was that 31 patients said they would refuse pain medications if such medications were offered. Twenty-five patients reported fear of addiction as their reason for this refusal.