Pain Management in the Emergency Chain: The Use and Effectiveness of Pain Management in Patients with Acute Musculoskeletal Pain

Jorien G.J. Pierik, Maarten J. Ijzerman, Menno I. Gaakeer, Sivera A. Berben, Fred L. van Eenennaam, Arie B. van Vugt, Carine J.M. Doggen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

39 Citations (Scopus)


Objective: While acute musculoskeletal pain is a frequent complaint in emergency care, its management is often neglected, placing patients at risk for insufficient pain relief. Our aim is to investigate how often pain management is provided in the prehospital phase and emergency department (ED) and how this affects pain relief. A secondary goal is to identify prognostic factors for clinically relevant pain relief. Design: This prospective study (PROTACT) includes 697 patients admitted to ED with musculoskeletal extremity injury. Data regarding pain, injury, and pain management were collected using questionnaires and registries. Results: Although 39.9% of the patients used analgesics in the prehospital phase, most patients arrived at the ED with severe pain. Despite the high pain prevalence in the ED, only 35.7% of the patients received analgesics and 12.5% received adequate analgesic pain management. More than two-third of the patients still had moderate to severe pain at discharge. Clinically relevant pain relief was achieved in only 19.7% of the patients. Pain relief in the ED was higher in patients who received analgesics compared with those who did not. Besides analgesics, the type of injury and pain intensity on admission were associated with pain relief. Conclusions: There is still room for improvement of musculoskeletal pain management in the chain of emergency care. A high percentage of patients were discharged with unacceptable pain levels. The use of multimodal pain management or the implementation of a pain management protocol might be useful methods to optimize pain relief. Additional research in these areas is needed.

Original languageEnglish
Pages (from-to)970-984
Number of pages15
JournalPain Medicine (United States)
Issue number5
Publication statusPublished - May 2015
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2015 American Academy of Pain Medicine.


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