Introduction and objectives Pain is common, with 43% of medical inpatients experiencing moderate to severe pain [Dix et al BJA 2004;92(2):235–237]. Factors contributing to inadequate pain relief include concerns about analgesic side effects, drug interactions and impact of treatment on co-morbidities. In respiratory in-patients we audited prevalence and severity of pain, adequacy of pain relief and contraindications to escalation of analgesia.
Methods Unselected adult inpatients (≥16 years) with respiratory disease managed on a respiratory specialist ward were included in the audit. Patients with lung cancer or chest drains were excluded. Diagnoses, investigation results and medications were collected from patient records and patients underwent pain assessment (Brief Pain Inventory). Analgesia was defined as inadequate if patients reported an average pain score or pain interference score (pain interfering with daily activities) >3/10 during the previous 24 h. For patients with inadequate analgesia, cautions and contraindications to analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) were determined to establish whether analgesia could be escalated.
Results Of 101 patients interviewed, main respiratory diagnoses were: COPD (40%), pneumonia/LRTI (38%), asthma (13%) and other (10%). 52 patients reported any pain in the last 24 h, of which the sites of worst pain were chest (44%), back (25%), limb (19%) and other (12%). Of these patients, 85% (n=44) were assessed as having inadequate analgesia. Abstract P226 Table 1 groups those patients with inadequate analgesia by position on the WHO analgesic ladder and details the proportion of patients who have no contraindication to stepping up the ladder. Abstract P226 Table 1 also highlights the proportion of patients who may benefit from adjuvant NSAID therapy. Of those patients with inadequate analgesia, 82% (n=36) had no contraindication to escalation of analgesia and 32% (n=14) had no contraindication to treatment with NSAIDs.
Conclusions Pain is common in hospital in-patients with respiratory disease. 44% of respiratory in-patients did not receive adequate analgesia. 82% of these had no contraindication to stepping up the pain ladder and 32% could have had an NSAID added to their treatment. Respiratory patients may benefit from closer assessment of their pain and options regarding prescribed analgesia.
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