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Show a 100 mm pain VAS at triage. Those with mild pain (VAS 1-33 mm) receive ibuprofen 600 milligrams (mg), moderate pain (VAS 34-66 mm) receive ibuprofen 600 mg and acetaminophen 650 mg/hydrocodone 10 mg, and those with severe pain (VAS > 66) receive either acetaminophen 650 mg/hydrocodone 10 mg or IV morphine titrated to pain relief. These medications may be administered at triage or at the time of placement into a treatment room prior to physician evaluation. Protocol driven pain management for patients presenting with extremity injury and back pain has resulted in substantial improvement in time to delivery of pain medication and the number of patients receiving pain medication. Mean time to delivery of pain medication has improved from 78 to 39 minutes, and the percentage of patients receiving pain medication has improved from 45% to 75%. Compliance with the triage protocol is high and 80% of all eligible patients are enrolled. Future Directions The next step in improving ED pain management is the expansion of the current ED pain survey to encompass an interactive pain registry (IPR). The IPR system will continuously build a pain database, process the data upon request to yield clinical and scientifically useful information in a just-in-time fashion, and foster the translation of that information into clinical and scientific knowledge about pain. A major focus of the initial data collection will be to establish and test evidence-based standards for the treatment of pain in the acute care setting of the ED. The interactive pain registry will attempt to improve pain management in the ED on several fronts. The first step will be the definition of the basic elements of pain assessment. This seemingly fundamental step in research design is lacking in consensus within the ED research community. The second step in the IPR will be the development of a hardware/ software system to allow integration of pain assessment and pain management data into electronic medical records systems. A critical third step in the IPR will be the programming of an automated system to allow follow-up of pain management protocols that are started in the ED. At the present time there are few studies in the emergency medicine literature that address the efficacy of ED pain management following discharge from the ED. Through the development of the interactive pain registry, the University of Utah hopes to answer a national call to develop patient oriented pain management outcome measures (Todd, 2001). References 1. Beel. T. L., J. C. Mitchiner, et al. (2000). Patient preferences regarding pain medication in the ED [In Process Citation]. Am J Emerg Med, 18(4): 376-380. 2. Bonica, J. (1987). Foreward. Pain Management in Emergency Medicine. P. M. Paris and R. D. Stewart. West Hartford, Connecticut, Apple-ton-Lange: xi-xii. 3. Cordell, W. H. (1996). Pain-control research opportunities and future directions. Ann Emerg Med, 27(4): 474-478. 4. Ducharme, J. (1994). Emergency pain management: A Canadian Association of Emergency Physicians (CAEP) consensus document. J Emerg Med, 12(6): 855-866. 5. Ducharme. J. (1996). Proceedings from the first international symposium on pain research in emergency medicine: Foreword. Ann Emerg Med, 27(4): 399-403. 6. Ducharme, J. and C. Barber (1995). A prospective blinded study on emergency pain assessment and therapy. J Emerg Med, 13(4): 571-575. 7. Fosnocht, D. E., E. R. Swanson. et al. (2001). Patient expectations for pain medication delivery. Am J Emerg Med, 19(5): 399-402. 8. Huskisson, E. (1983). Visual Analog Scales. Pain Measurement and Assessment. R. Melzack. New York, RAven Press: 33-37. 9. Johnston, C. C, A. J. Gagnon. et al. (1998). One-week survey of pain intensity on admission to and discharge from the emergency department: a pilot study. J Emerg Med, 16(3): 377-382. 10. Jones, J. B. (1999). Assessment of pain management skills in emergency medicine residents: the role of a pain education program. J Emerg Med, 17(2): 349-354. 11. Lee. W. W., A. E. Burelbach, et al. (2001). Hispanic and non-Hispanic white patient pain management expectations. Am J Emerg Med, 19(7): 549-550. 12. Lewis. L. ML L. C. Lasater, et al. (1994). Are emergency physicians too stingy with analgesics? South Med J, 87(1): 7-9. 13. Terndrup. T. E. (1996). Establishing pain policies in emergency medicine. Ann Emerg Med, 27(4): 408-411. 14. Todd, K. H. (2001). Patient-oriented outcome measures: the promise of definition. Ann Emerg Med, 38(6): 672-674. 15. Wallenstein, S. (1984). Scaling Clinical Pain and Pain Relief. New York: Elsevier Science Publishers. 16. Wilson, J. E. and J. M. Pendleton (1989). Oligoanalgesia in the emergency department. Am J Emerg Med, 7(6): 620-623. About the Authors David Fosnocht and Eric Swanson are assistant professors and attending physicians in the University of Utah Emergency Department. Questions and comments should be directed to (801) 581-2730 or davefosnocht@home.com. 12 Utah's Health: An Annual Review Volume VIII |