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ED Patients Who Need Pain Drugs May Want to Seek Care at Night

November 11, 2016

By Lisa Rapaport

(Reuters Health) - Emergency department patients may be more likely to get needed pain medication when they're younger and don't show up during the day, an Australian study suggests.

Compared with patients seen from midnight to 8 o'clock in the morning, those seeking care from 8 a.m. to 4 p.m. were 38 percent less likely to receive pain medication in the emergency department, the analysis of data from one hospital in Melbourne found.

Patients over 55 were 19 percent less likely to receive pain drugs than adults 35 and under, while patients over 75 had 32 percent lower odds of getting pain relief, the study also found.

"It is not known why these patient subgroups are less likely to get analgesia - we can only speculate at this stage," said lead study author David Taylor of Austin Health in Australia.

"It may be that staff are a bit too busy in the daytime or that older patients are more sensitive to powerful analgesics and staff are less inclined to use them," Taylor added by email.

Patients who required interpreters were 58 percent less likely to get pain medication than people who didn't need language assistance, the study also found.

It's possible "there is a communication barrier with patients who need an interpreter and they are less able to let staff know that they have substantial pain," Taylor said.

To assess which patients may be more or less likely to receive pain medication, researchers examined data on 1,289 people treated in an emergency department in Melbourne in July and August 2013.

In Australia, nurses can prescribe and administer pain to patients under many circumstances. Researchers looked at how often nurses did this and also examined how often patients received pain drugs within 30 minutes of being seen in the emergency department.

All of the patients were at least 18 years old and reported having pain.

Overall, 745 patients, or 58 percent, received some type of pain relief in the emergency department, researchers report in Emergency Medicine Journal, online October 27.

Nurses administered pain drugs to 419 of these patients. People were more likely to get pain medication from nurses if they had moderate to severe pain or if they had medical problems that should be treated within 30 to 60 minutes.

When patients were older or received some pain relief during an ambulance ride to the hospital, however, they had lower odds of getting pain medication from nurses.

Among the patients who did get pain drugs, 248 received this medication within 30 minutes. This was more likely with severe pain.

Limitations of the study include the substantial number of people who didn't get pain medication, which left a smaller group of people to analyze for factors that influence analgesia use, the authors note.

Even so, the findings add to a growing body of evidence suggesting that not all emergency department patients who need pain medication are getting it, said Matthew Douma, a researcher at Royal Alexandra Hospital in Alberta, Canada.

To improve their likelihood of receiving pain medications, patients should ask for it, Douma, who wasn't involved in the study, said by email.

Beyond discomfort, untreated pain can be associated health problems such as breathing difficulties and poor wound healing, Douma noted.

"Patients often do not want to be a burden or cause a problem, but they shouldn't hesitate to speak with the nurse-in-charge if their requests for analgesia were not attended to," Douma said.


Emerg Med J 2016.

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