Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20200188
Brazilian Journal of Pain
Original Article

Impact of acute pain and analgesic adequacy in hospitalized patients

Impacto da dor aguda e adequação analgésica em pacientes hospitalizados

Marina de Góes Salvetti; Paulo Carlos Garcia; Maria Aparecida Medeiros Lima; Carolina Gallo Fernandes; Cibele Andrucioli de Mattos Pimenta

http://dx.doi.org/10.5935/2595-0118.20200188 BrJP, vol.3, n4, p.333-336, 2020
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Abstract

BACKGROUND AND OBJECTIVES: Pain is a frequent symptom in the hospital environment. The study aimed to identify the impact of acute pain on activities of daily living and to analyze analgesic adequacy.

METHODS: Cross-sectional study carried out in six units of a University Hospital. Patients were assessed for the presence and intensity of pain and impact on activities of daily living. Analgesic adequacy was assessed by the Pain Management Index. The association between pain and sociodemographic and clinical characteristics was investigated using the Chi-square test. A logistic regression model was applied to assess the impact of pain intensity on activities.

RESULTS: 134 patients, mean age 53 years, were evaluated. At the moment of the interview 37 (27.6%) participants reported pain and 58 (45.7%) reported pain in the 24 hours before the interview. The average pain intensity was 6.6±2.4 and the pain was more frequent in patients in the Emergency Department, Intensive Care Unit and Internal Medicine. There was an association between pain and the female sex and there was no association with hospitalization unit, diagnosis, and specialty. Pain affected the ability to eat (p=0.036) and sleep (p=0.008). Most prescriptions (68%) were unsuitable for pain intensity.

CONCLUSION: Frequency of pain was high, was more prevalent in women, and significantly impaired the ability to eat and sleep. Inadequacy of the analgesic regimen regarding intensity of pain was found in more than half of the patients, indicating that it's necessary to improve pain control in the hospital environment.

Keywords

Acute pain, Analgesia, Pain, Nursing

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor é um sintoma frequente no ambiente hospitalar. O estudo objetivou identificar o impacto da dor aguda sobre as atividades de vida diária e analisar a adequação analgésica.

MÉTODOS: Estudo transversal desenvolvido em seis unidades de um Hospital Universitário. Os pacientes foram avaliados quanto à presença e intensidade da dor e prejuízos às atividades de vida diária. A adequação analgésica foi avaliada pelo Índice de Manejo da Dor. A associação entre a dor e as características sociodemográficas e clínicas foi investigada por meio do teste Qui-quadrado. Um modelo de regressão logística foi aplicado para avaliar o impacto da intensidade da dor nas atividades.

RESULTADOS: Foram avaliados 134 pacientes, com média de idade de 53 anos. No momento da entrevista 37 (27,6%) participantes referiram dor e 58 (45,7%) relataram dor nas 24h que antecederam a entrevista. A intensidade média da dor foi 6,6±2,4 e a dor foi mais frequente em pacientes do Pronto Atendimento, Unidade de Terapia Intensiva e Clínica Médica. Houve associação entre dor e sexo feminino e não foi encontrada associação com unidade de internação, diagnóstico e especialidade. A dor afetou a capacidade de comer (p=0,036) e dormir (p=0,008). A maior parte das prescrições (68%) estava inadequada à intensidade da dor.

CONCLUSÃO: A frequência de dor foi alta e a incidência maior no sexo feminino, afetando de modo significativo a capacidade de comer e dormir. A prescrição de fármacos era inadequada à intensidade da dor em mais da metade dos pacientes, indicando a necessidade de aprimorar os protocolos de controle da dor.

Palavras-chave

Analgesia, Dor, Dor aguda, Enfermagem

References

Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011;11(1):770.

Polomano RC, Dunwoody CJ, Krenzischek DA, Rathmell JP. Perspective on pain management in the 21st century. Pain Manag Nurs. 2008;9(1^sSuppl):S3-S10.

Williamson KJ, Stram ML. The Epidemiology of Inadequate Control of Acute Pain. Pain. 2019:1005-7.

Tighe P, Buckenmaier III CC, Boezaart AP, Carr DB, Clark LL, Herring AA. Acute pain medicine in the United States: a status report. Pain Med. 2015;16(9):1806-26.

Dunwoody CJ, Krenzischek DA, Pasero C, Rathmell JP, Polomano RC. Assessment, physiological monitoring, and consequences of inadequately treated acute pain. J Perianesth Nurs. 2008;9(1^sSuppl):S15-27.

Meissner W, Coluzzi F, Fletcher D, Huygen F, Morlion B, Neugebauer E. Improving the management of post-operative acute pain priorities for change. Curr Med Res Opin. 2015;31(11):2131-43.

Cousins MJ, Lynch ME. The Declaration Montreal: access to pain management is a fundamental human right. Pain. 2011;152(12):2673-4.

Damico V, Murano L, Cazzaniga F, Dal Molin A. Pain prevalence, severity, assessment, and management in hospitalized adult patients: a result of a multi-center cross-sectional study. Ann Ist Super Sanita. 2018;54(3):194-200.

Karcioglu O, Topacoglu H, Dikme O, Dikme O. A systematic review of the pain scales in adults: which to use?. Am J Emerg Med. 2018;36(4):707-14.

Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med. 1994;330(9):592-6.

Silva EJ, Dixe MA. Prevalência e características de dor em pacientes internados em hospital português. Rev Dor. 2013;14(4):245-50.

Ramia E, Nasser SC, Salameh P, Saad AH. Patient perception of acute pain management: data from three tertiary care hospitals. Pain Res Manag. 2017;2017:7459360.

Tegegn HG, Gebreyohannes EA. Adequacy of cancer pain management and pain interference with daily functioning among patients visiting the oncology ward of an Ethiopian University. J Glob Oncol. 2017;3(2^sSuppl):35s.

Gregory J, McGowan L. An examination of the prevalence of acute pain for hospitalised adult patients: a systematic review. J Clin Nurs. 2016;25(5-6):583-98.

Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287-98.

Pozek JPJ, Beausang D, Baratta JL, Viscusi ER. The acute to chronic pain transition: can chronic pain be prevented?. Med Clin North Am. 2016;100(1):17-30.

Schug SA, Palmer GM, Scott DA, Halliwell R, Trinca J. Acute pain management: scientific evidence. Med J Aust. 2016;204(8):315-7.

Cuomo A, Bimonte S, Forte CA, Botti G, Cascella M. Multimodal approaches and tailored therapies for pain management: the trolley analgesic model. J Pain Res. 2019;12:711-4.

Gatchel RJ, Reuben DB, Dagenais S, Turk DC, Chou R, Hershey AD. Research agenda for the prevention of pain and its impact report of the work group on the prevention of acute and chronic pain of the Federal Pain Research Strategy. J Pain. 2018;19(8):837-51.

Fillingim RB. Individual differences in pain understanding the mosaic that makes pain personal. Pain. 2017;158(Suppl 1):S11-8.

Dedicação AC, Sato TO, Avila MA, Moccellin AS, Saldanha ME, Driusso P. Prevalence of musculoskeletal pain in climacteric women of a Basic Health Unit in São Paulo/SP. Rev Dor. 2017;18(3):212-6.

Sorge RE, Totsch SK. Sex differences in pain. J Neurosci Res. 2017;95(6):1271-81.

Becker B, McGregor AJ. Men, women, and pain. Gend Genome. 2017;1(1):46-50.

Zoëga S, Sveinsdottir H, Sigurdsson GH, Aspelund T, Ward SE, Gunnarsdottir S. Quality pain management in the hospital setting from the patient's perspective. Pain Pract. 2015;15(3):236-46.

Buysse DJ. Sleep health can we define it? Does it matter?. Sleep. 2014;37(1):9-17.

Costa SV, Ceolim MF. Fatores que interferem na qualidade do sono de pacientes internados. Rev Esc Enferm USP. 2013;47(1):46-52.

Boakye PA, Olechowski C, Rashiq S, Verrier MJ, Kerr B, Witmans M. A critical review of neurobiological factors involved in the interactions between chronic pain, depression, and sleep disruption. Clin J Pain. 2016;32(4):327-36.

Manzoli JPB, Correia MDL, Duran ECM. Definição conceitual e operacional das características definidoras do diagnóstico de enfermagem Padrão de Sono Prejudicado. Rev Lat Am Enfermagem. 2018;26.

Moreno CRDC, Santos JLF, Lebrão ML, Ulhôa MA, Duarte YAD. Problemas de sono em idosos estão associados a sexo feminino, dor e incontinência urinária. Rev Bras Epidemiol. 2019;21(Suppl 2).

Te Boveldt N, Vernooij-Dassen MJFJ, Burger N, Ijsseldijk M, Vissers K, Engels Y. Pain and its interference with daily activities in medical oncology outpatients. Pain Physician. 2013;16(4):379-89.

Shi Q, Mendoza TR, Dueck AC, Ma H, Zhang J, Qian Y. Determination of mild, moderate, and severe pain interference in patients with cancer. Pain. 2017;158(6):1108-12.

Sousa-Muñoz RLD, Rocha GES, Garcia BB, Maia AD. Prevalência de dor e adequação da terapêutica analgésica em pacientes internados em um hospital universitário. Medicina (Ribeirão Preto). 2015;48(6):539-48.

Reis-Pina P, Lawlor PG, Barbosa A. Adequacy of cancer-related pain management and predictors of undertreatment at referral to a pain clinic. J Pain Res. 2017;10:2097.

García CA, Garcia JBS, Rosario Berenguel Cook MD, Colimon F, Flores Cantisani JA, Guerrero C. Undertreatment of pain and low use of opioids in Latin America. Pain Manag. 2018;8(3):181-96.

Ribeiro SBF, Pinto JCP, Ribeiro JB, Felix MMS, Barroso SM, Oliveira LFD, Sousa FA. Dor nas unidades de internação de um hospital universitário. Rev Bras Anestesiol. 2012;62(5):605-11.

Vargas-Schaffer G. Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician. 2010;56(6):514-7.

Helander EM, Menard BL, Harmon CM, Homra BK, Allain AV, Bordelon GJ. Multimodal analgesia, current concepts, and acute pain considerations. Curr Pain Headache Rep. 2017;21(1):3.

Submitted date:
05/01/2020

Accepted date:
07/26/2020

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