Monday, November 3, 2003

This presentation is part of : Health Care Delivery Problem Solving

Pain Prevalence in Hospitalized Patients of a German University Teaching Hospital

Barbara Strohbuecker, MScN, University of Witten/Herdecke; University of Cologne, Cologne, Germany, Herbert Mayer, PhD, University of Witten/Herdecke, Witten, Germany, Rainer Sabatowski, MD, Pain Clinic, Department of Anesthesiology, University of Cologne, Cologne, Germany, and George C.M. Evers, RN, PhD, Faculty of Medicine, Institute for Nursing Research, University of Witten/Herdecke, Witten, Germany.
Learning Objective #1: Learn about the method of conducting an epidemiological study
Learning Objective #2: Learn about pain prevalence of inpatients and about quality of pain therapy

Objective: Identify strengths and weaknesses of pain management

Design: Descriptive, cross-sectional

Sample, Setting: 825 inpatients of 48 units of a university teaching hospital in Germany were enrolled; patients had to be at least 18 years and able to speak German. Intensive care, psychiatric, maternal and paediatric units were excluded.

Variables studied: Prevalence of pain during interview at rest and on movement and pain during 24 hours before interview; pain intensity at rest and on movement as well as worst pain 24 hours before interview; localization, duration, causes of pain and pain medication.

Methods: Structured interviews were conducted by an independent researcher. Pain intensity was measured with a 10 cm visual analogue scale (VAS). Chart analysis was carried out to check for pain medication, ICD-10 and demographic data. To evaluate adequacy of pain man-agement, Pain Management Index (PMI) was computed by comparing pain medication (WHO-analgesic ladder) and pain levels.

Findings: 561 patients participated, 50% had pain during interview and 63% had pain during the preceding 24 hours. 58% had moderate or severe pain (above VAS 44 mm) and 36% reported severe pain (above VAS 64 mm). Every second patient with pain received pain medication, those who had passed surgery (p = 0.002) and those who had severe pain (p < 0.001) had a greater chance to get analgesics. However, 30% of those with VAS above 64 mm received no analgesic and only 24% had adequate medication. A negative PMI to indicate inadequate pain therapy was found in 44% (246/559) of the sample. 33% had pain for more than six months, pain in the lower extremities was most prevalent (35%).

Conclusions: Pain prevalence and intensity were high and pain therapy was inadequate in many cases. Pain management needs to be improved by continuous assessment and adequate pain medication.

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