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The impact of emergency department patient-controlled analgesia (PCA) on the incidence of chronic pain following trauma and non-traumatic abdominal pain - 17/1/2019


Anaesthesia 2019; 74: 69-73

Introduction

The effect of patient-controlled analgesia during the emergency phase of care on the prevalence of persistent pain is unknown. These authors studied individuals with traumatic injuries or abdominal pain 6 months after hospital admission via the emergency department using an opportunistic observational study design.

Methods


This follow-up study was conducted using postal questionnaires that were sent to participants recruited to the multi-centre pain solutions in the emergency setting study. Patients with prior chronic pain states or opioid use were not studied. Questionnaires included the EQ5D, the Brief Pain Inventory and the Hospital Anxiety and Depression scale.

 

Results


Overall, 141 out of 286 (49% 95%CI 44-56%) patients were included in the study. Participants presenting with trauma were more likely to develop persistent pain than those presenting with abdominal pain (45 out of 64 (70%) versus 24 out of 77 (31%); 95% confidence interval [CI] 24% to 54%; p<0.001). There were no statistically significant associations between persistent pain and analgesic modality during hospital admission, age or sex. Across both abdominal pain and traumatic injury groups, participants with persistent pain had lower EQ5D mobility scores, worse overall health and higher anxiety and depression scores (p<0.05). In the abdominal pain group, 13 out of 50 (26%) patients using patient-controlled analgesia developed persistent pain versus 11 out of 27 (41%) of those with usual treatment (95% CI for difference [control – patient-controlled analgesia] –8% to 39%; p=0.183). Acute pain scores at the time of hospital admission were higher in participants who developed persistent pain (95% CI 0.7 to 23.6; p=0.039). For traumatic pain, 25 out of 35 (71%) patients given patient-controlled analgesia developed persistent pain versus 20 out of 29 (69%) patients with usual treatment (95% CI –30% to 24%; p=0.830).

 

Conclusions

The authors conclude that persistent pain is common 6 months after hospital admission, particularly following trauma, and that it may be possible to reduce persistent pain (at least in patients with abdominal pain) by delivering better acute pain management. They advise that further research is needed to confirm this hypothesis.


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ArticleDate:20190117
SiteSection: Abstracts



 
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