APS Press Room

News Highlights from The Journal of Pain • September 2006
The Peer Review Journal of the American Pain Society

 
For immediate release Contact: Chuck Weber
(847) 705-1802

Why Wait for Pain Relief?

Factors Associated with Delay to Analgesia in Emergency Departments
Glenn Arends and Margaret Fry, St. George Hospital, Kogara, Australia

Waiting time for administration of opiate analgesia is used to measure the quality of care in hospital emergency departments. According to the authors, it remains unclear if specific demographic and clinical variables are associated with analgesia delays. Therefore, the intent of this study was to determine the proportion of emergency department patients that require intravenous opiate analgesia and what, if any, factors can predict when it might take more than an hour before administration of the initial dose.

This is the first study to establish a predictive model for delay to analgesia. For three months, the authors examined medical records of 857 patients who received parenteral opiate analgesia in the emergency department. They found that 52.6 percent were treated in less than 60 minutes. For those who waited longer than 60 minutes, the study concluded:

  • There is a perception among medical staff that that patients with lower emergency codes require less pain relief
  • Patients seen by junior staff are more likely to experience analgesia delay
  • Medical staff are reluctant to provide analgesia to ED patients when a diagnosis isn’t clear
  • Three in four patients enduring analgesia delays do not receive alternative pain relief prior to the administration of opioids.

The authors recommended that triage-nurse-initiated pain management may offset inefficiencies in the timely delivery of analgesia. They pointed out that expanding or introducing triage-nurse-initiated pain management can significantly reduce time to analgesia. Further, studies show that nurse-initiated narcotic administration is safe and efficient and can assist in the diagnostic process.

How Do Symptoms Differentiate Neuropathic from Non-Neuropathic Pain?

SYMPTOM PROFILES DIFFER IN PATIENTS WITH NEUROPATHIC VS. NON-NEUROPATHIC PAIN
Robert H. Dworkin, Mark P. Jensen, Arnold R. Gammaitoni, David O. Olaleye and Bradley S. Galer, University of Rochester School of Medicine and Dentistry and University of Washington School of Medicine

To test their hypothesis that patients with neuropathic and non-neuropathic pain have different symptom profiles, the authors examined 618 patients with peripheral neuropathic pain conditions, osteoarthritis and low-back pain before their treatments had begun.

They found that specific pain symptoms differ between patients with peripheral neuropathic pain and those with inflammatory and musculoskeletal pain. In particular, patients with neuropathic pain reported significantly more hot, cold, sensitive, itchy and surface pain. Non-neuropathic pain subjects rated dull and deep pain as their most intense discomfort. However, sharp pain, which usually is associated with neuropathic conditions, was the only symptom with no discrimination between the groups.

The authors concluded that clinical methods should be developed for characterizing the profile of different symptoms to profile a patient’s pain, assist in diagnosis, and provide guides to underlying mechanisms and treatment targets.

A RECONSIDERATION OF THE RELEVANCE OF SYSTEMIC LOW-DOSE KETAMINE TO THE PATHOPHYSIOLOGY OF FIBROMYALGIA
Patrick B. Wood, McGill University, Montreal, Canada

An estimated 2 percent of the US population has fibromyalgia, a condition characterized by pain and tenderness to light palpation, chronic fatigue and sleep disturbances. Unlike patients with rheumatoid arthritis, fibromyalgia patients have multi-systemic symptoms, suggesting that pain from the disorder could be caused by impaired regulation of the neurotransmitter dopamine. This finding casts doubt on previous understanding that NDMA receptors contribute to fibromyalgia syndrome, and that the disease can be managed with low-does ketamine therapy. Myers concluded that the growing body of evidence pointing to dopamine dysregulation as a possible cause of fibromyalgia pain may explain the heterogeneous symptom complex that characterizes fibromyalgia syndrome.