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Multicenter Study
. 2014 Dec;155(12):2568-2574.
doi: 10.1016/j.pain.2014.09.017. Epub 2014 Sep 20.

Is all pain is treated equally? A multicenter evaluation of acute pain care by age

Ula Hwang  1 , Laura K Belland, Daniel A Handel, Kabir Yadav, Kennon Heard, Laura Rivera-Reyes, Amanda Eisenberg, Matthew J Noble, Sudha Mekala, Morgan Valley, Gary Winkel, Knox H Todd, Sean R Morrison
Affiliations
Multicenter Study

Is all pain is treated equally? A multicenter evaluation of acute pain care by age

Ula Hwang et al. Pain. 2014 Dec.

Abstract

Pain is highly prevalent in health care settings; however, disparities continue to exist in pain care treatment. Few studies have investigated if differences exist based on patient-related characteristics associated with aging. The objective of this study was to determine if there are differences in acute pain care for older vs younger patients. This was a multicenter, retrospective, cross-sectional observation study of 5 emergency departments across the United States evaluating the 2 most commonly presenting pain conditions for older adults, abdominal and fracture pain. Multivariable adjusted hierarchical modeling was completed. A total of 6,948 visits were reviewed. Older (⩾ 65 years) and oldest (⩾ 85 years) were less likely to receive analgesics compared to younger patients (<65 years), yet older patients had greater reductions in final pain scores. When evaluating pain treatment and final pain scores, differences appeared to be based on type of pain. Older patients with abdominal pain were less likely to receive pain medications, while older patients with fracture were more likely to receive analgesics and opioids compared to younger patients. Differences in pain care for older patients appear to be driven by the type of presenting pain.

Keywords: Acute pain care; Emergency department; Geriatrics.

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Conflict of interest statement

The authors have no conflicts of interest.

Figures

Figure 1
Figure 1
Comparison of initial analgesic medication given to each type of presenting pain according to age category (n=6,948) NSAIDs = nonsteroidal anti-inflammatory drugs. †Statistically significant associations in multivariable hierarchical modeling when clustering by site and treating clinician and adjusting for gender, race/ethnicity, ESI, presenting pain, Charlson comorbidity score, number of current medications, abdominal pain or fracture type, admission, and degree of initial pain when using YOUNG as referent group for comparison.
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