Sat., 10/15/11 Peds, Ger, Hip, Femur & IP, Paper #77, 11:20 am OTA-2011
Δ Pain and Satisfaction with Pain Management in Hospitalized Trauma Patients
Kristin R. Archer, PhD1; Renan C. Castillo, PhD2; Stephen T. Wegener, PhD3;
Christine M. Abraham, MS1; William T. Obremskey, MD1;
1Vanderbilt University Medical Center, Nashville, Tennessee, USA;
2Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA;
3Johns Hopkins Medicine, Baltimore, Maryland, USA
Purpose: The primary objective of this study was to determine the level of pain and satisfaction with pain management in hospitalized orthopaedic trauma patients. A secondary objective was to examine the association between patient self-efficacy and pain beliefs and pain and satisfaction outcomes at hospital discharge, after controlling for demographics, injury characteristics, and psychological distress. The main hypothesis was that decreased self-efficacy and negative pain beliefs along with psychological distress would be associated with increased pain and decreased satisfaction at hospital discharge.
Methods: This study prospectively enrolled 213 patients (representing 265 surgeries), 19 to 86 years of age, admitted to a Level 1 trauma center for surgical treatment of lower-extremity (80%), upper-extremity (12%), and pelvis/acetabular (8%) injuries between November 2009 and November 2010. The current analysis excluded 15 patients without a discharge assessment, resulting in 250 surgeries requiring at least 24 hours in the hospital (94% follow-up rate). Participants were enrolled postoperatively on the orthopaedic unit and answered questions on demographics and preinjury health. A discharge assessment measured pain intensity and interference with activity (Brief Pain Inventory [BPI]); satisfaction with pain management, self-efficacy, and pain beliefs (American Pain Society Patient Outcome Questionnaire); and depression and posttraumatic stress disorder (PTSD). Clinical characteristics were abstracted from the medical record. Associations between patient variables and pain and satisfaction outcomes were analyzed using multilevel multivariable logistic regression techniques.
Results: 241 trauma patients (96%) reported pain at the time of hospital discharge. Of the patients with pain, 37% reported mild pain (BPI 1-4); 35%, moderate pain (BPI 5-6); and 24%, severe pain (BPI 7-10). 14% of trauma patients were dissatisfied with pain treatment overall. 22% of patients with moderate to severe pain were dissatisfied and 2% of patients with no to mild pain were dissatisfied (P <0.001). Separate multilevel multivariable regression analyses demonstrated that decreased self-efficacy for pain management and increased levels of depressive symptoms were associated with moderate to severe pain intensity and interference with activity at hospital discharge, after controlling for demographics and PTSD (P <0.05). Moderate to severe pain and increased levels of depressive symptoms were associated with decreased satisfaction at hospital discharge, after controlling for self-efficacy, pain beliefs, and PTSD (P <0.05).
Conclusions: A significant minority of hospitalized trauma patients report severe pain and dissatisfaction with pain treatment. Results imply that efforts to improve pain assessment and management among hospitalized orthopaedic trauma patients are needed. Addressing patient self-efficacy and depression during the hospital stay may improve pain and satisfaction outcomes among patients with traumatic orthopaedic injury. Improved communication between physicians who are responsible for care and mental health providers is recommended.
Funding: This research supported by an OTA grant.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.