Treating Acute Pain in Prehospital Settings

Photo courtesy of Pixabay
Photo courtesy of Pixabay

Many times, when someone has to go to the hospital for an emergency, they are in excruciating pain from a broken bone, a deep cut, or something gone awry internally like a burst appendix.

However, patients’ pain is often not treated in the prehospital setting by EMTs or paramedics despite the fact that providing adequate pain relief is known to minimize anxiety and cardiac complications associated with acute pain.

There is a concern that treating a patient’s pain before they go to the hospital will prevent the doctors there from making an accurate diagnosis if the patient cannot assess their pain accurately. Additionally, due to growing concerns over the rampant opioid epidemic in this U.S., many healthcare personnel are using opioid painkillers much more cautiously.

The Agency for Healthcare Research and Quality (AHRQ) awarded $355,000 to two professors from the University of Connecticut’s School of Pharmacy to address issues associated with acute pain management in the prehospital setting. Drs. William Baker, Jr. and Diana Sobieraj will work with a team of other experts, including Dr. Richard Kamin from the University of Connecticut School of Medicine and Dr. Mark Cicero from the Yale School of Medicine, to review the existing literature on various analgesics used to treat acute pain in the prehospital setting.

With this project, Baker and Sobieraj have received more than $1 million in funding from the AHRQ for their research initiatives.

Their team will look at both different formats for patients to report their pain and different pain mitigation treatments, including non-opioid pain killers such as ketamine.

The current system for adolescents and adults requires them to ascribe a numerical value to their pain, which is subjective and unreliable among those who are less able to express themselves.

A strong base of research does not support currently recommended scales for patients to self-assess and report their pain in the prehospital setting. These scales may not work well in certain populations including those with cognitive impairments, non-English speakers, and those who are under the influence of drugs or alcohol.

As part of the project, Baker and Sobieraj’s team also will gather data on populations who have been excluded from previous studies. By looking at the criteria that led these patients to have their data excluded, the researchers will be able to construct better recommendations on types of patients who might not be suited to receive standard treatments for their acute pain.

A comprehensive review of research on the various aspects of acute pain management will improve patients’ prehospital experience while still ensuring they will receive the most appropriate treatment in the emergency setting.

Separately, UConn recently launched a pain consortium to address the need for increased research and education about pain and pain management. The consortium is led by Reinhard Laubenbacher, a joint faculty member at UConn Health and The Jackson Laboratory for Genomic Medicine.

Dr. Baker received his Pharm.D. from UConn and Dr. Sobieraj received her Pharm.D. from the University of Rhode Island. Their research focuses on the application of systematic review and meta-analysis to study comparative effectiveness of pharmacologic therapies.

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