Characterizing the pain score trajectories of hospitalized adult medical and surgical patients: A retrospective cohort study

Thomas Kannampallil*, William L. Galanter, Suzanne Falck, Michael J. Gaunt, Robert D. Gibbons, Robert McNutt, Richard Odwazny, Gordon Schiff, Allen J. Vaida, Diana J. Wilkie, Bruce L. Lambert

*Corresponding author for this work

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Pain care for hospitalized patients is often suboptimal. Representing pain scores as a graphical trajectory may provide insights into the understanding and treatment of pain. We describe a 1-year, retrospective, observational study to characterize pain trajectories of hospitalized adults during the first 48 hours after admission at an urban academic medical center. Using a subgroup of patients who presented with significant pain (pain score >4; n 7762 encounters), we characterized pain trajectories and measured area under the curve, slope of the trajectory for the first 2 hours after admission, and pain intensity at plateau. We used mixed-effects regression to assess the association between pain score and sociodemographics (age, race, and gender), pain medication orders (opioids, nonopioids, and no medications), and medical service (obstetrics, psychiatry, surgery, sickle cell, intensive care unit, and medicine). K-means clustering was used to identify patient subgroups with similar trajectories. Trajectories showed differences based on race, gender, service, and initial pain score. Patients presumed to have dissimilar pain experiences (eg, sickle vs obstetrical) had markedly different pain trajectories. Patients with higher initial pain had a more rapid reduction during their first 2 hours of treatment. Pain reduction achieved in the 48 hours after admission was approximately 50% of the initial pain, regardless of the initial pain. Most patients' pain failed to fully resolve, plateauing at a pain score of 4 or greater. Visualizing pain scores as graphical trajectories illustrates the dynamic variability in pain, highlighting pain responses over a period of observation, and may yield new insights for quality improvement and research.

Original languageEnglish (US)
Pages (from-to)2739-2746
Number of pages8
JournalPain
Volume157
Issue number12
DOIs
StatePublished - Aug 10 2016

Keywords

  • Hospital
  • Pain score
  • Quality improvement
  • Trajectory

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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    Kannampallil, T., Galanter, W. L., Falck, S., Gaunt, M. J., Gibbons, R. D., McNutt, R., Odwazny, R., Schiff, G., Vaida, A. J., Wilkie, D. J., & Lambert, B. L. (2016). Characterizing the pain score trajectories of hospitalized adult medical and surgical patients: A retrospective cohort study. Pain, 157(12), 2739-2746. https://doi.org/10.1097/j.pain.0000000000000693