From ACEP:
Emergency patients who have more control over the dosing of their acute pain medication have better and faster pain relief than patients who do not. The results of the study were reported online Friday in the Annals of Emergency Medicine (“Randomized Clinical Trial Comparing A Patient-Driven Titration Protocol of IV Hydromorphone to Traditional Physician-Driven Management of Emergency Department Patients with Acute Severe Pain”).
“This study showed that a simplified, patient-centered, easily remembered titration strategy using a potent opioid rapidly leads to adequate and safe pain relief when compared to usual care, in which physicians alone determine when and how much pain medication to give,” said lead study author Andrew K. Chang, MD, of the Department of Emergency Medicine at Montefiore Medical Center in Bronx, NY. “Adequate pain management in the emergency department has historically been suboptimal, so development and testing of new ways to treat patients with acute pain – including different medications and involving patients in their own treatment – is important to the practice of emergency medicine.”
The patient-driven hydromorphone (a morphine derivative) pain protocol was created to simultaneously address two common problems with acute pain management: inappropriately low dosing of intravenous opioids and lack of follow-up pain medication. The patient-driven pain protocol patients were given an initial dose of the more potent opioid hydromorphone and 15 minutes later were asked if they wanted more pain medication. Twenty-nine percent of those who were given the option said yes. Overall, patients in the patient-driven pain protocol achieved a higher level of pain relief than those in the physician-driven group.
“More than 90 percent of the patients in the patient-driven group achieved adequate pain control,” said Dr. Chang. “This has the potential to lead to better care and more comfort for patients in acute severe pain in emergency departments that are growing more crowded and understaffed. Most people fear pain that cannot be managed. This is an important step toward getting pain under control quickly and effectively.”
Filed under: Uncategorized
