A NEW METHOD FOR ASSESSING PAIN IN THE EMERGENCY DEPARTMENT: A PILOT STUDY

Transcription

1 A NEW METHOD FOR ASSESSING PAIN IN THE EMERGENCY DEPARTMENT: A PILOT STUDY DANA IM, MD, MPP, MPHIL HARVARD AFFILIATED EM RESIDENCY MGH/BWH

2 MEASURING PAIN IN THE ED Pain is the most common chief complaint in ED 78% of primary reason for ED visit

3 REACTIONS TO THE OPIOID EPIDEMIC

4 JOINT COMMISSION STATEMENT ON PAIN MANAGEMENT New Statement on Pain Management (April 18, 2016) The hospital conducts a comprehensive pain assessment that is consistent with its scope of care, treatment, and services The hospital uses methods to assess pain that are consistent with the patient's age, condition, and ability to understand. The hospital reassesses and responds to the patient's pain, based on its reassessment criteria.

5 MEASURING PAIN IN THE ED Göransson et al, AJEM 2016: ED patients perceive visual analog scale and numeric rating scale as insufficient The scales do not include the consequences of the severity of pain, including the effects on daily functions.

6 BRIEF PAIN INVENTORY SHORT FORM (BPI-SF) Purpose: To assess the severity of pain and the impact of pain on daily functions Populations: Chronic pain (cancer, osteoarthritis, LBP) and acute pain (postoperative pain) Length: 17 item scale, approx. 5 minutes 5 Areas of Pain Assessment

7 PAIN INTENSITY

8 PAIN INTERFERENCE

9 LOCATION, TREATMENT, & RELIEF

10 WHY BPI-SF? Reliability: for pain intensity and interference Validity: compared to other methods, such as SSF-36 Bodily Pain Responsiveness: changes seen before and after treatment M. Pelayo-Alvarez, et al. J Palliat Med., 16 (2013), pp

11 STUDY DESIGN Longitudinal, non-blinded survey of ED patients using the BPI-SF to describe their pain to understand usability and utility of the form Site Brigham and Women s ED Period March April 2017 Population Mode Exclusion Criteria 100 patients presenting with CC of chest pain, abdominal pain, or MSK pain Self administered or administered by trained research assistants + additional questions Non-English speaker, unable to provide informed consent, dementia/mental repairmen, prisoner, employee/student

12 AIM 1 Aim 1: To assess the utility of using the BPI-SF as an alternative to the numerical rating scale (NRS) for assessing pain in the ED and to determine the feasibility of administering the BPI-SF in the ED. NRS vs. BPI-SF Time needed to complete the form

13 AIM 2 Aim 2: To determine if the BPI-SF scores correlate with the severity of pain assessed by the NRS in the ED setting and to identify the average NRS score at which patients would feel satisfied with the treatment provided in the ED. Compare the NRS and the BPI scale scores (intensity/interference) Assessing satisfactory NRS scores after intervention

14 PRELIMINARY DATA Demographics: 103 patients enrolled Mean Age: 37.9 Gender # of Patients Female 69 (69.0%) Male 31 (31.0%) Omitted 3 (2.9%) Type of Pain # of Patients MSK 21 (21.0%) Chest 21 (21.0%) Abdominal 53 (53.0%) Multiple 5 (5.0%) Omitted 3 (2.9%) Race # of Patients American Indian or Alaska Native 1 (1.0%) Asian 4 (4.1%) Black or African American 24 (24.5%) White 53 (54.1%) Other 15 (15.3%) Omitted 5 (4.9%)

15 PRELIMINARY DATA Self-Administered (n=81): 3 min 33 sec RA-Administered (n=19): 4 min 36 sec Pain Chronicity # of Patients Chronic 33 (32.0%) Acute 70 (68.0%)

16 Pain level on arrival to ED General activity Mood Walking ability Normal work Relationships with others Sleep Enjoyment

17 PRELIMINARY DATA At what level of pain would you feel satisfied with treatment provided in the ED? # of Patients NRS Satisfied Pain Score

18 PRELIMINARY DATA BPI-SF compared to NRS? Favorability # of Patients Better 76 (74.5%) Neutral 13 (12.7%) Worse 13 (12.7%) Omitted 1 (1.0%)

19 DISCUSSION What we ve learned so far: BPI-SF considered the better tool for assessing pain (utility) Takes minutes to complete (feasibility) Variability in expectations Pending analyses: Compare NRS to BPI-SF pain intensity/interference scores Multivariate regression analysis to evaluate whether the satisfactory NRS scores after treatment of pain correlate with subgroup characteristics.

20 ACKNOWLEDGMENTS Mentor: Scott Weiner, MD, MPH Grant: MACEP Resident Research Grant Support: Daniel Pallin, MD Eric Nadel, MD, Harvard-Affiliated Emergency Medicine Residency at MGH/BWH Brigham and Women s Hospital Emergency Medicine Research Group Research Assistants

21 REFERENCES 1. Cordell WH, Keene KK, Giles BK, Jones JB, Jones JH, Brizendine EJ. The high prevalence of pain in emergency medical care. Am J Emerg Med. 2002;20(3): doi: /ajem Todd KH, Ducharme J, Choiniere M, et al. Pain in the Emergency Department: Results of the Pain and Emergency Medicine Initiative (PEMI) Multicenter Study. J Pain. 2007;8(6): doi: /j.jpain Baker D. Joint Commission Statement on Pain Management. Executive Vice President, Healthcare Quality Evaluation, The Joint Commission. Published Accessed September 28, Downie WW, Leatham PA, Rhind VM. Studies with pain rating scales. Ann Rheum Dis. 1978: Göransson KE, Heilborn U, Djärv T. Patients perspectives on the insufficiency of scales to rate their pain in the ED. Am J Emerg Med. 2016;S (16): doi: /j.ajem Cleeland C, Ryan K. pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23((2)): Ferreira KA, Teixeira MJ, Mendonza TR, Cleeland CS. Validation of brief pain inventory to Brazilian patients with pain. Support Care Cancer. 2011;19(4): doi: /s Larue F, Colleau SM, Brasseur L, Cleeland CS. Multicentre Study Of Cancer Pain And Its Treatment In France Author ( s ): François Larue, Sophie M. Colleau, Louis Brasseur and Charles S. Cleeland Published by : BMJ Stable URL : Multicentre study of cancer pain. BMJ. 1995;310(6986): Serlin C, Edwards KR, Cleeland CS. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain. 1995;61: Beck SL, Falkson G. Prevalence and management of cancer pain in South Africa. Pain. 2001;94(1): doi: /s (01) Gauffin E, Oster C, Sjoberg F, Gerdin B, Ekselius L. Health-related quality of life (EQ-5D) early after injury predicts long-term pain after burn. - PubMed - NCBI. Burns. 2016:4-11. doi: /j.burns Keller S, Bann CM, Dodd SL, Schein J, Mendoza TR, Cleeland CS. Validity of the Brief Pain Inventory for Use in Documenting the Outcomes of Patients With Noncancer Pain. Clin J Pain. 2004;20(5): Breitbart W, Passik S, McDonald M V., et al. Patient-related barriers to pain management in ambulatory AIDS patients. Pain. 1998;76(1-2):9-16. doi: /s (98) Beauregard L, Pomp A, Choinière M. Severity and impact of pain after day-surgery. Can J Anaesth. 1998;45(4): doi: /bf Schiffmann R, Kopp JB, Iii HAA, Balow JE, Brady RO. Enzyme Replacement Therapy in Fabry Disease: A Randomized Controlled Trial. JAMA. 2016;285(21):

22 A NEW METHOD FOR ASSESSING PAIN IN THE EMERGENCY DEPARTMENT: A PILOT STUDY DANA IM, MD, MPP, MPHIL HARVARD AFFILIATED EM RESIDENCY MGH/BWH

23 SUPPLEMENT SLIDES

24 WHY BPI-SF? Reliability, Validity, and Sensitivity to Change Test-retest reliability for malignant pain: good reliability for pain intensity (r=0.8) and pain interference (r=0.8) Internal consistence: high for severity scale (0.81 < α < 0.89) and interference scale (0.88 < α < 0.95) Criterion validity: Moderate relationship between BPI intensity and interference scales and SF-36 Bodily Pain (Spearman s correlation coefficient 0.47 < r < 0.65) Responsiveness: Before vs. After THR: showed large responsiveness indices M. Pelayo-Alvarez, et al. J Palliat Med., 16 (2013), pp