Patient Controlled Medication Found Effective For Abdominal Pain In ER

MedicalResearch.com Interview with:
Prof. Jason Smith
Consultant in Emergency Medicine, Derriford Hospital, Plymouth, UK
Royal College of Emergency Medicine Professor
Defence Professor of Emergency Medicine, Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, UK
Honorary Professor in Emergency Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, UK

Medical Research: What is the background for this study?

Prof. Smith: Patients commonly present to emergency departments in pain. When patients are asked about their emergency department experience, they often say that more could have been done to manage their pain.

Routine care for patients in moderate or severe pain who present to emergency departments usually involves intravenous (IV) morphine, delivered by a nurse. There may be a delay when patients are admitted to a hospital ward before they are reviewed by the admitting medical team, when their pain needs are reassessed.

Patient controlled analgesia (PCA) is used to good effect elsewhere in the hospital.
The aim of this study was to compare PCA with routine care in patients presenting to emergency departments with either traumatic injuries or non-traumatic abdominal pain, who require admission to hospital.

Medical Research: What are the main findings?

Prof. Smith: We found that significant reductions in pain were possible using patient controlled analgesia in patients with abdominal pain. Patients spent significantly less time in moderate or severe pain, and were more likely to be very or perfectly satisfied with their pain management.

In patients with traumatic injuries, a modest (but non-significant) reduction in pain was seen in patients allocated to the PCA group compared with the routine care group. Patients in the PCA group were more likely to be very or perfectly satisfied with their pain management.

Medical Research: What should clinicians and patients take away from your report?

Prof. Smith: Multimodal analgesia including opiates is effective at managing pain in emergency patients, but significant improvements can be gained by using patient controlled analgesia in some groups. Patient controlled analgesia should be considered as an option when dealing with patients in pain, particularly those in whom repeated doses of intravenous opiates are required.

Medical Research: What recommendations do you have for future research as a result of this study?

Prof. Smith: Patient controlled analgesia may be useful in other groups that have not yet been studied in the emergency setting, such as children. Novel methods of dealing with patients in pain in emergency departments need to be investigated. This may involve novel methods of drug delivery (intranasal, buccal, inhaled) or drugs.

http://www.bmj.com/content/350/bmj.h2988
and
http://www.bmj.com/content/350/bmj.h3147

Citation:

Smith Jason E, Rockett Mark, Creanor Siobhan, Squire Rosalyn, Hayward Chris, Ewings Paul et al. PAin SoluTions In the Emergency Setting (PASTIES)—patient controlled analgesia versus routine care in emergency department patients with non-traumatic abdominal pain: randomised trial 2015; 350 :h3147

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Prof. Jason Smith, Consultant in Emergency Medicine, Derriford Hospital, Plymouth, UK, & Royal College of Emergency Medicine Professor (2015). Patient Controlled Medication Found Effective For Abdominal Pain In ER 

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