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Patient Safety/Quality

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Although high-intensity pain has been linked to adverse outcomes, many hospitalized patients report severe pain as acceptable

Untreated pain has been associated with problems ranging from impaired functional recovery and higher rates of postoperative complications to longer hospital stays and higher costs. Although it is not in patients' best interests to let high-intensity pain remain undertreated, a new study found that 31 percent of patients at one hospital considered such pain acceptable. They considered the pain acceptable because it had resolved (34 percent), they believed the pain would eventually go away (19 percent), or they were able to tolerate the pain (19 percent).

Patients already being treated with analgesics (nonsteroidal anti-inflammatory drugs, acetaminophen, or opioids) were 30 to 40 percent less likely to consider severe pain acceptable compared with patients not receiving analgesics. One possible explanation is that patients who reported their severe pain to be acceptable were less likely to request or accept analgesics. On the other hand, analgesic therapy may be a marker for patients who have had their pain recognized, have sought and received treatment, but have not yet achieved relief. A third possibility is that providing suboptimal analgesic therapy may have shifted the experience of severe pain from acceptable to unacceptable when patients became aware that pain relief was possible.

Older patients were 1.5 percent less likely than younger patients and black patients were 30 percent less likely than white patients to describe severe pain as acceptable. These are important findings, given that earlier studies have shown that geriatric and minority patients are less likely than younger and white patients to receive appropriate opioid therapy. Studies directed at improving the management of pain should target both pain intensity and patients' beliefs about the acceptability of severe pain, conclude the Mount Sinai School of Medicine researchers who conducted the study. Their work was supported in part by the Agency for Healthcare Research and Quality (HS10539). They conducted daily interviews with 1,254 patients admitted to nine medical/surgical units in a New York City hospital. Patients were asked about pain intensity (using a 4-point scale), analgesic use, and acceptance of pain.

Details are in "Acceptability of severe pain among hospitalized adults," by Catherine L. Maroney, M.A., M.P.H., Ann Litke, M.A., M.F.A., Daniel Fischberg, M.D., Ph.D., and others, in the June 2004 Journal of Palliative Medicine 7(3), pp. 443-450.

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