Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-02T16:50:09.204Z Has data issue: false hasContentIssue false
  • English
  • Français

Measurement of Pain in the Prehospital Setting Using a Visual Analogue Scale

Published online by Cambridge University Press:  28 June 2012

Bill A. Lord  and
Brian Parsell
Bill A. Lord*
Affiliation:
Senior Lecturer, Monash University Centre for Ambulance and Paramedic Studies, Frankston VIC, Australia
Brian Parsell
Affiliation:
Acting Assistant Operations Manager- Southwestern Sydney Area Ambulance Service of New South Wales, Sydney, Australia
*
Monash University Centre for Ambulance and Paramedic Studies, PO Box 527, Frankston VIC 3199 Australia, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

The aim of this study was to use a visual analogue scale (VAS) to measure the adequacy of prehospital pain management. Patients reported pain severity at two points in time during treatment and transport by ambulance paramedics. The change in pain score was compared with a benchmark reduction of 20 mm that has been shown to correspond with the minimum clinically significant change in pain perception reported by patients.

Methods:

This prospective, observational study used a VA S to record pain severity among patients reporting pain who were transported to a hospital by paramedics. Patients used a VAS to score pain severity during the initial patient assessment process (T0), and again at the hospital of destination (Tend). This study reports the mean changes in the scores, and the percentage of cases for whom the difference between T0and Tend in the study population achieved or exceeded the 20 mm benchmark. A survey also was administered to paramedics who participated in this study in order to identify attitudes, values, and beliefs relating to the measurement of pain.

Results:

A total of 262 patients were enrolled in this study. The mean value for thereduction in VAS (T0-Tend) was 18.2±23.9 mm [±SD] (Median = 14.0mm, 95% confidence interval (CI) = 15.3–21.1 mm). One hundred and thirty-four patients (51.1%) did not receive analgesia (either morphine sulfate or methoxyflurane). The mean initial (T0) pain score for the no-analgesia group was 54.5 ±24.7 mm [±SD], with the mean value for the change in VAS (T0-Tend) = 10.6 mm (median = 5 mm, 95% CI = 6.4–14.8 mm). Fo rty-six patients (17.6%) recorded some deterioration in their pain score at Tend (T0-Tend<0 mm). Survey results identified attitudes that may affect paramedics' pain management practice.

Conclusion:

The results suggest that inadequate analgesia is an issue in this study setting. Effective analgesia requires formal protocols or guidelines supported by effective analgesic therapies along with education that addresses attitudes that may inhibit pain assessment or management by paramedics. Regular audits form part of clinical quality assurance programs that assess analgesic practice. However, such auditsmust have access to data obtained from patient self-reporting of pain using a valid and reliable pain measurement tool.

Keywords

benchmarkingemergency medical servicesemergency medical technicianspain measurementprehospitalvisual analogue scale
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 18 , Issue 4 , December 2003 , pp. 353 - 358
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Wilson, JE, Pendleton, JM: Oligonalgesia in the emergency department. Am J EmergMed 1989;7:620–623.CrossRefGoogle ScholarPubMed
2. Oden, R: Acute postoperative pain: Incidence, severity and etiology of inadequate treatment. Anesthesiol Clin North Amer 1989;7:1–5.CrossRefGoogle Scholar
3. Pargeon, KL, Hailey, BJ: Barriers to effective cancer pain management: A review of the literature. J Pain Symptom Manage 1999;18:358–368.CrossRefGoogle ScholarPubMed
4. Chambers, JA, Guly, HR: The need for better prehospital analgesia. Arch Emerg Med 1993;10(3):187–192.CrossRefGoogle Scholar
5. Ricard-Hibon, A, Chollet, C, Saada, S, Loridant, B, Marty, JA: A quality control program for acute pain management in out-of-hospital critical care medicine. Ann EmergMed 1999;34(6):738–744.CrossRefGoogle ScholarPubMed
6. White, LJ, Cooper, JD, Chambers, RM, Gradisek, RE: Prehospital use of analgesia for suspected extremity fractures. Prehosp Emerg Care 2000;4(3): 205–208.CrossRefGoogle ScholarPubMed
7. Vassiliadis, J, Hitos, K, Hill, CT: Factors influencing prehospital and emergency department analgesia administration to patients with femoral neck fractures. Emerg Med (Fremantle) 2002;14(3):261–266.CrossRefGoogle ScholarPubMed
8. Maio, RF, Garrison, HG, Spaite, DW et al: Emergency Medical Services OutcomesProject (EMSOP) IV: Pain measurement in out-of-hospital outcomes research. Ann Emerg Med 2002;40(2):172–179.CrossRefGoogle ScholarPubMed
9. Ducharme, J: Whose pain is it anyway? Managing pain in the emergency department. Emerg Med (Fremantle) 2001;13(3):271–273.CrossRefGoogle ScholarPubMed
10. Lee, JS: Pain measurement: Understanding existing tools and their application in the emergency department. Emerg Med (Fremantle) 2001;13(3): 279–287.CrossRefGoogle ScholarPubMed
11. Bijur, PE, Silver, W, Gallagher, EJ: Reliability of the visual analogue scale for measurement of acute pain. Acad Emerg Med 2001;8(12):1153–1157.CrossRefGoogle ScholarPubMed
12. Lee, JS, Stiell, IG, Hobden, E, Papa, L, Wells, G: Clinically meaningful values of the visual analogue scale of pain severity. Acad Emerg Med 2000;7:550.Google Scholar
13. Todd, KH, Funk, JP: The minimum clinically important difference in physician-assigned visual analog pain scores. Acad Emerg Med 1996;3:142–146.CrossRefGoogle ScholarPubMed
14. Kelly, AM: Setting the benchmark for research in the management of acute pain in emergency departments. Emerg Med (Fremantle) 2001;13(1):57–60.CrossRefGoogle ScholarPubMed
15. National Health and Medical Research Council (NHMRC): Acute pain management: Scientific evidence. Canberra: Commonwealth of Australia, 1999.Google Scholar
16. Ho, K, Spence, J, Murphy, MF: Review of pain measurement tools. Ann Emerg Med 1996;27(4):427–432.CrossRefGoogle ScholarPubMed
17. Chambers, JA, Guly, HR: Prehospital intravenous nalbuphine administered by paramedics. Resuscitation 1994;27(2):153–158.CrossRefGoogle ScholarPubMed
18. Clarke, TNS, Ennis, BP, Joicey, P, Meehan, C: Paramedic administered anal-gesia-an appraisal of current practice. Prehospital Immediate Care 1998;2:123–127.Google Scholar
19. Max, MB: Improving outcomes of analgesic treatment: is education enough? Ann Intern Med 1990;113(11):885–889.CrossRefGoogle Scholar

A correction has been issued for this article:

Erratum