Tessa Quinn
Pain is one of the most common reasons adults seek medical care. Chronic pain, in particular, has been linked to numerous physical and mental health conditions, including anxiety and depression, and can lead to restrictions in mobility and daily activities. It is also associated with high healthcare costs and lost productivity. While the prevalence of chronic pain among US adults ranges from 11% to 40%estimated 20.4% of US adults experiencing chronic pain in 2016, it is clear that pain is a significant issue that contributes to a substantial number of hospital visits.
| Characteristics | Values |
|---|---|
| Pain is a common reason for hospital visits | Pain is common in hospitalized patients |
| Types of pain | Acute pain, Chronic pain |
| Acute pain | Sudden, short-term pain caused by injury, trauma, or medical treatment |
| Acute pain duration | Less than a month |
| Chronic pain | Pain lasting beyond the healing period, typically more than three months |
| Chronic pain causes | Underlying medical disease or condition, injury, medical treatment, inflammation, or unknown cause |
| Chronic pain impact | Affects physical functioning, mental health, and quality of life |
| Chronic back pain | One of the most common health problems in the United States |
| Patient concerns | Fear of addiction, side effects, additional costs, and injections |
| Physician concerns | Insufficient knowledge of pain management, suboptimal pain control |
| Physician barriers | Physician competency, recall bias, interviewer bias |
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What You'll Learn
Chronic back pain and patient satisfaction
Pain is a common reason for hospital visits, and it can significantly impact a person's life, affecting their mood, sleep, and ability to move around and think clearly. While acute pain typically lasts for a short period, chronic pain persists beyond the normal healing period (usually beyond three months). Chronic back pain, in particular, is a prevalent issue, with an estimated 70-80% of American adults experiencing it at some point in their lives.
Chronic back pain can have a significant impact on patients' lives, leading to repeated medical visits and unmet needs and expectations. Patients with chronic back pain may seek diagnostic tests, new treatments, or referrals to specialists to validate their suffering and find relief. However, the standard primary care approach of brief visits, medications, exercise, and physical therapy may not be sufficient for these patients.
Patient satisfaction among individuals with chronic low back pain has been the subject of several studies. These studies have examined the associations between patient satisfaction and various factors, including physician communication, physician empathy, opioid prescribing, pain intensity, physical function, and health-related quality of life. Physician communication and empathy have been found to be strongly associated with patient satisfaction. Patients with chronic pain value physicians who demonstrate empathy and clearly communicate treatment plans and expectations.
A collaborative approach that involves both the patient and physician in clinical decision-making has been linked to better outcomes among patients with chronic low back pain. This patient-centred communication enhances patient engagement in chronic pain self-management. However, there has been relatively less research on physician empathy in treating chronic pain, despite patients often feeling misunderstood and isolated.
To improve patient satisfaction, clinicians should consider eliciting patients' views on the underlying causes of their chronic back pain and their expectations from office visits. By adopting a collaborative and empathetic approach, clinicians can enhance patient satisfaction and provide more effective care for individuals suffering from chronic back pain.
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Acute pain and its causes
Pain is a complex and subjective experience that varies from person to person. It serves as a warning sign, indicating that something is wrong or that there is a threat to the body. Acute pain is a type of pain that comes on suddenly and is typically caused by a specific event or condition. It is sharp and intense, and it usually doesn't last longer than six months.
Acute pain can have various causes, including illness, injury, trauma, or medical procedures. For example, someone may experience acute pain after surgery, a car accident, or a sports injury. It can also be caused by more specific issues such as broken bones, dental work, burns, cuts, or infections. Additionally, childbirth and labour are common causes of acute pain.
The duration of acute pain can range from a few minutes to several months. It generally disappears once the underlying cause has been treated or healed. However, if the pain persists for more than three to six months after recovery, it is then classified as chronic pain.
It is important to note that acute pain can significantly impact a person's daily life, affecting their mood, sleep, appetite, and ability to move around. Therefore, effective pain management is crucial. Individuals experiencing acute pain should not hesitate to speak to hospital staff and medical professionals about their pain. Describing the pain accurately helps healthcare providers find the best treatment options, which may include medications, physical therapy, or other interventions.
Additionally, individuals can play an active role in managing their acute pain. This can include taking over-the-counter medications like acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs), undergoing massage therapy, and participating in stretching and strengthening exercises. It is important to remember that pain is not something one has to adjust to or endure; seeking relief and treatment is essential for overall well-being.
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Pain management in hospitals
Pain is a common reason for hospital visits, with back pain being a leading symptom prompting visits to orthopedic surgeons and neurosurgeons. While in the hospital, patients may experience pain as a result of their condition or treatment, which can affect their mood, sleep, and ability to move around and think clearly. Acute pain is common following surgery or physical trauma, such as damage to skin or muscle tissues, and usually goes away once the damaged area has healed. Chronic pain, on the other hand, extends beyond the normal healing period and can exist without a clear reason.
Effective pain management in hospitals is crucial for patient recovery and well-being. It begins with an accurate pain screening and assessment to develop an individualized management plan. Patients should be encouraged to describe their pain clearly, including its impact on their daily activities, to help hospital staff identify the best treatment. For example, patients can inform staff about the intensity of pain, how it affects their appetite, sleep, mood, and ability to move around.
It is important for patients to ask for pain relief as soon as they start feeling pain. Regular medication can help manage pain better than waiting for it to become unbearable. Hospital staff may offer pain assessments and ask patients if they are in pain. Patients should answer these questions honestly to receive the necessary pain management support. Patients and their families should actively participate in planning their treatment and setting recovery goals.
Various strategies are available for pain management in hospitals. Medications, both opioid and non-opioid, are commonly used to manage pain. However, due to the challenges of opioid misuse, multimodal analgesia, or "rational polypharmacy," is recommended. This approach combines lower doses of multiple medications with complementary mechanisms to maximize benefits and minimize risks. Additionally, non-pharmacologic treatments such as acupuncture, massage therapy, physical therapy, relaxation techniques, and cognitive behavioral therapy are also effective in pain management. These complementary therapies can be offered based on patient preferences, and hospitals can provide education on accessing these treatments post-discharge if they cannot be provided during hospitalization.
Overall, pain management in hospitals requires a consistent, systematic, and holistic approach. Hospitals should have defined criteria and tools for screening, assessing, and reassessing pain, ensuring that patient preferences and safety are prioritized. By addressing pain effectively, hospitals can improve patient outcomes and enhance recovery.
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Barriers to adequate pain management
Pain is a leading cause of hospital visits, and inadequate pain management affects 80% of the global population. Several barriers hinder health care professionals from achieving optimal pain management.
System-related barriers
These include a lack of clearly defined standards and pain management protocols, and limited access to pain specialists and analgesics.
Staff-related barriers
These include inadequate knowledge and skills, and lack of teamwork.
Physician-related barriers
The inadequate education of healthcare professionals is a major and persistent barrier to effective pain management. Despite the health professions’ development of competencies in pain management, core pain management competencies for pre-licensure, entry-level health professionals have not yet been established. The limited pain education that is currently provided may be ineffective because it focuses on traditional, impersonal topics such as anatomy and physiology that may have little direct relevance to the complex daily problems faced by patients, families, and clinicians.
Patient-related barriers
Patients with chronic pain report many unmet needs and expectations. Overall satisfaction might be improved if clinicians elicit patients' views of underlying causes and their expectations from office visits. Many patients also want a diagnostic test, a new treatment, or a referral to a specialist to validate their suffering.
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Opioids for pain treatment
Pain is a leading cause of hospital visits, and opioids are a class of drugs often used for pain treatment. They are derived from or mimic substances found in the opium poppy plant. Opioids work by activating opioid receptors in the brain and body, blocking pain signals. Examples include morphine, oxycodone, hydrocodone, codeine, and fentanyl. While effective for pain relief, opioids carry a high risk of addiction and other side effects such as drowsiness, constipation, nausea, and slowed breathing.
Opioids can be legally prescribed by doctors or obtained illegally, and both forms can induce euphoria, leading to repeated use and addiction. This has resulted in an opioid crisis, with millions of Americans affected by opioid abuse and addiction. To combat this, the FDA promotes evidence-based prescribing guidelines and access to treatment for opioid use disorder.
When used appropriately and under medical supervision, prescription opioids can help manage pain effectively. However, misuse or abuse can lead to serious consequences, including overdose and death. It is crucial to follow the prescribed duration and dosage to mitigate the risk of addiction and adverse effects.
In a hospital setting, pain management is essential for patient recovery. Acute pain, typically resulting from surgery or physical trauma, should be addressed promptly with medication and other strategies. Chronic pain, persisting beyond the expected healing period, requires identifying and treating the underlying cause. Patients are encouraged to describe their pain and its impact on daily life to help hospital staff determine the best treatment approach.
Upon discharge, patients prescribed opioid pain medication should be aware of potential side effects and discuss any concerns with their doctor. It is important to follow the prescribed regimen and be vigilant about potential signs of addiction or adverse reactions.
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Frequently asked questions
Pain is one of the most common reasons adults seek medical care, with chronic pain prevalence among U.S. adults ranging from 11% to 40% in 2016. However, it is unclear whether pain is the leading cause of hospital visits as the data focuses on chronic pain and does not provide a comparison with other reasons for hospital visits.
Several factors contribute to the prevalence of pain-related hospital visits. Socioeconomic status, including education, poverty, and health insurance coverage, plays a role in both general health status and specific health conditions. Additionally, age and the type of pain experienced can influence the likelihood of a hospital visit, with adults aged 18-44 experiencing a notable decrease in pain-related visits from 49.1% to 21.3% between 2010 and 2020.
Hospitals are implementing strategies to manage pain during patient visits. The use of opioids in emergency departments has decreased across all age groups between 2010 and 2020, with a particular focus on reducing opioid prescriptions for younger patients. Alternative pain management techniques and medications are likely being utilized, but specific strategies may vary across different hospitals and healthcare teams.
