Future Directions: Improving ED
There is little formal education on pain management as noted by Selbst and Clark in 1990. 151 Astonishingly, Bonica, in a 1985 text, reviewed 25,000 pages in 50 major textbooks for medicine, surgery, pediatrics, and emergency medicine and found only 54 pages devoted to the management of pain. 152 Additionally, few medical schools include acute pain control in their core curriculum. 153
In 1998, Chan and Verdile looked prospectively at patient satisfaction with pain control by 48-hour follow- up surveys. This study was done approximately three years after the institution of an annual one-hour lecture on pain management for emergency medicine residents and four required sessions annually for staff physicians and nurses on patient satisfaction, focusing on awareness and treatment of pain. They found a high (91%) satisfaction rate and a high rate of analgesic prescriptions (95%). These rates are higher than that previously described in the literature. Education of staff and residents may be the difference. 154
In 1999, Jones prospectively assessed a pain education program for EM residents. A study including a questionnaire and serial VAS scores was conducted before and after the institution of a four-hour pain management program for the residents. There was an improvement in patientís 30-minute pain reduction from 65% to 92% of patients. 152 The problem with pain control in the pediatric population is not the difficulty of controlling pain, but the inconsistency with which analgesia is offered. Patient assessment, which addresses pain, can prompt the treatment of pain. Pain is consistently reduced when there are supportive measures in place and when pediatric-focused annual nurse competencies are used. 155
It is clear that this is an area in need of development. Better education of resident physicians, staff physicians, and nurses on the issues surrounding pain management is paramount to improving patientís pain relief with the added benefit of probable improved patient satisfaction.