SCOPE OF THE PROBLEM

The concepts of patient expectation and desired outcomes for patients with acute pain in the emergency department (ED) are surprisingly simple. Most patients present to the ED with pain. Patients with pain expect pain relief. The obvious desired outcome is relief of pain. Our ability to move from this simplistic ideal to scientific, evidence-based solutions that facilitate patient expectations, at the same time defining reasonable outcomes for pain relief, is much more complex. This complexity accounts for a great deal of the continued problem of inadequate pain management in the ED.

CLINICAL ASSESSMENT

The clinical assessment of pain is one of the more challenging aspects of defining patient expectations and outcomes for pain relief. Pain assessment methods have various advantages and disadvantages in ease of use, scientific validity, and practicality for use with different patient populations. Unfortunately each pain assessment process suffers from the common question of “What does a pain score of ‘X’ mean?”

The lack of clinician confidence in pain measurement translates to even more confusion in trying to use these scales to define pain relief outcomes. The task of defining and meeting individual patient expectations for pain relief is similarly complex. At the present time there is no widely accepted assessment tool available that defines patient expectations for pain relief or delineates appropriate outcomes for pain relief.