An analysis of pain control strategies in hospitalized trauma patients

Pain in trauma has a role similar to the double-edged sword. On the one hand, pain is a good indicator to determine the severity and type of injury. Apparently, the incidence of trauma has been high and is considered to have increased throughout the years (World Health Organization [WHO]. Hospital admissions were reportedly ۲.۳ million in the United States and ۵.۷ million in European countries (Centers for Disease Control and Prevention [CDC]. Most trauma patients were admitted due to motor-vehicle collisions (MVC) or falls. Likewise, in Indonesia, the incidence of trauma from MVC accounted for close to ۱.۳ million every year. This number is indicated that MVC was sitting in the top ۱۰ of leading causes of death. Previous research in Western countries found a high prevalence of moderate to severe pain in trauma patients during hospitalization. For instance, ۸۰ percent of musculoskeletal injury patients in a study conducted by Rosenbloom perceived moderate to severe pain when they were admitted to a large hospital in Canada. Similarly, most patients with other types of trauma, such as burns and orthopedics injuries rated the same level of pain. Also, two qualitative studies have interviewed hospitalized trauma patients in westernized cities of Asia. These studies revealed that most trauma patients with orthopedic and burn injuries reported severe pain during hospitalization.On the other hand, pain can induce sever complications and it may lead to further deterioration of the patient. Therefore, knowing how to manage pain in trauma patients is an important part of systemic approach in trauma. The aim of this manuscript is to provide information about pain management in trauma in the Emergency Room settings. In this review we searched among electronic and manual documents covering a ۱۵-yr period between ۲۰۰۰ and ۲۰۱۶. Our electronic search included Pub Med, Google scholar, Web of Science, and Cochrane databases. We looked for articles in English and in peer-reviewed journals using the following keywords: acute pain management, trauma, emergency room and injury. More than ۳۲۰۰ documents were identified. After screening based on the study inclusion criteria, ۵۶۰ studies that had direct linkage to the study aim were considered for evaluation based World Health Organization (WHO) pain ladder chart. To provide adequate pain management in trauma patients require: adequate assessment of age-specific pharmacologic pain management; identification of adequate analgesic to relieve moderate to severe pain; cognizance of serious adverse effects of pain medications and weighting medications against their benefits, and regularly reassessing patients and reevaluating their pain management regimen. Patient-centered trauma care will also require having knowledge of barriers to pain management and discussing them with the patient and his/her family to identify solutions.

Keywords:

Pain , Pain management , Trauma , WHO