“In both studies, the relative increase in satisfaction scores with PCA was greater than the relative reduction in pain scores, suggesting that patients attach more value to autonomy in pain management than to the magnitude of pain experienced,” Dr. Lecky said.
Taken together, the PASTIES studies suggest that starting PCA in the ED is “likely to be beneficial for patients who have needed a bolus of intravenous opiate analgesia for initial pain management, particularly when severe pain recurs during their stay in the emergency department. Patients with a similar clinical profile to those in the PASTIES studies are most likely to benefit; however, extrapolation to other groups is not unreasonable, particularly when a second bolus of intravenous opiate is being considered,” Dr. Lecky said.
She concluded, “We know that PCA devices are safe and effective in the postoperative setting, where they have been used extensively since the 1990s. Cost effectiveness—although not described in PASTIES—is unlikely to be a major barrier for emergency departments, as the small investment in reusable equipment and set-up time is more than likely to be recuperated by reductions in the nursing time spent administering additional bolus opiates. The acronym for the PCA device should perhaps be reattributed to ‘patient centered analgesia,’ as these devices clearly deliver an autonomy that is highly valued by many patients.”
Dr. Smith told Reuters Health, “As a result of the findings of these trials, we have instituted a PCA protocol for use in our emergency department, and hope that other emergency departments will follow suit and add this to the armory of analgesia options available to emergency physicians.”
The PASTIES studies were funded by the National Institute for Health Research. The authors and Dr. Lecky have no disclosures.
Pages: 1 2 | Single Page
One Response to “Patient-Controlled Analgesia Works in the Emergency Department”
July 26, 2015
John CastleI’m a 67 y/o WM PA. I have chronic pain from my 35 years of Naval service which included years of “humping” with the Marines. As a result of the above, I’m a “chronic pain” patient with a lot of spinal DJD. I also have had contact with the medical system as an acute pain patient for myself, and my wife just had a C-section. In all of these encounters it appears to me that we have more of a pain control problem than just using a PCA in the ER.
For twenty (20) years I have been on Tramadol prn for “break through” arthritis pain. I was never an “addict” until the FDA made tramadol a controlled medication. Now I can only get tramadol by “doctor shopping.” And everyone wants to send me for “injections” to protect themselves, and the injections have a checkered perception based on mixed results on studies of their efficacy.
I had an acute prostatitis a few weeks ago. I could ONLY get tramadol for that pain, since the urgent care clinic didn’t carry triplicates and couldn’t give me anything “stronger.” Tylenol #3 wasn’t even offered. To directly ask for something stronger put me at risk of being identified as a “drug seeker,” and that medical record was available to the entire medical center, including to my bosses. It was a risk I was unwilling to take.
My wife just had a C-section. The OB dept didn’t have triplicates and so could only give her Tylenol #3, a condition for which for many years a woman would get a hydrocodone or Percocet RX.
For years we’ve endured EBM that said we weren’t providing our patients enough pain control, thus the irritating evolution of asking 4 y/o children their pain level from 1-10 with a happy face schema to help them describe it. Now it doesn’t matter because the Schedule of controlled drugs now controls our medicine and EBM doesn’t matter.
I remember when my attending at Naval Medical Center San Diego bawled me out for not giving a few Vicodin to a patient to keep them from lodging a complaint against us and thus hurting our quality scores. We as practitioners are continually complaining about the “drug seeker.” Now we can’t even control real pain in patients because the feds control our practice. And as a PA I am dedicated to practicing within the parameters of my supervising physician. If he/she is a wimp and afraid of the feds, the patient suffers.
Physicians — any answers?
Blessings.