SCOPE OF THE PROBLEM

Painful musculoskeletal injuries are undertreated in the emergency department (ED). The Joint Commission on Accreditation of Healthcare Organizations states that “unrelieved pain has adverse physical and psychological effect” and that pain should be “assessed in all patients.” Despite this, an analysis of the ED component of the National Center for Health Statistics National Hospital Ambulatory Medical Care Survey showed that only 59% of patients with orthopedic injuries had documented pain scores. Perhaps more concerning, in acute care patients with documented moderate or severe pain, analgesia has not historically been prescribed in as many as 25% of patients. This failure to address analgesic needs in adult patients is typically worse for pediatric patients with as many as 40% of children not receiving analgesic therapy for acute musculoskeletal injuries.

These findings have been replicated in many studies and indicate that analgesics are not routinely prescribed to patients with orthopedic injuries, even if they describe their pain as moderate to severe. In order to optimize analgesia for patients in all populations, it is essential for the medical provider to routinely identify, document, and treat the pain associated with injuries, particularly acute musculoskeletal injuries.

CLINICAL ASSESSMENT

The assessment of acute musculoskeletal injuries is generally straightforward. Unlike pain secondary to a medical event, the pain of orthopedic trauma can usually be readily identified.