Do we really know if they are in pain? A cross-sectional study in hospitalised adult patients in Spain.
Laura Lorenzo Allegue, Leonor Laredo Velasco, Ana María Recio Vivas and 5 others
PMID 37789558WHAT IT FOUND
At interview, 36.7% of hospitalised adults had pain, but nurse-recorded pain often did not match patient reports.
Pain was assessed systematically three times a day in only 17%, and only 52% with pain intensity score 3.5 or higher had adequate analgesic management.
Key findings
01At the time of interview, pain was present in 36.7% of patients, moderate to severe pain was present in 20.4% of the sample, and the median VAS score among patients in pain was 4 (interquartile range 2 to 5).
02Only 17% of patients had pain assessed systematically three times a day, and agreement between patient-reported pain and nurse observation-chart pain was slight (Kappa 0.20).
0393% of patients in pain were prescribed analgesics, but only 52% of patients with pain intensity score 3.5 or higher had a positive Pain Management Index.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done in one tertiary hospital in Madrid, so the results may not apply to other hospitals or countries. It excluded patients in emergency, intensive care, post-anaesthesia, psychiatry and palliative care units, and patients with cognitive impairment or unable to speak Spanish, so it says nothing about common groups in whom pain is hard to assess. Because the design was cross-sectional and the paper reports associations between records and treatment, it does not test whether changing records improves analgesic management. Missing records limited the concordance analyses: nurse qualitative and chart agreement was evaluated in 33% of the sample, and patient versus chart agreement in 44%. The Pain Management Index was originally validated for cancer pain and was used here for all hospitalised patients. Patient self-report in a hospital setting may be biased by vulnerability and dependence on staff.
Declared interests
The authors received no specific funding and declared no conflict of interest.
The easy way to misread this
Do not conclude pain treatment was adequate because 80% of patients given analgesia reported good relief. Only 52% of patients with pain intensity score 3.5 or higher had a positive Pain Management Index, and only 17% of patients had pain assessed systematically three times a day.