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Review of: Marco C, Plewa M, Buderer N, et al: "Self-reported pain scores in the emergency department: Lack of association with vital signs" Academic Emergency Medicine. 2006. 13:974–979.
The Science
The researchers in this study undertook the task of determining whether or not there is a correlation between subjective self-reported pain scores by patients and their vital signs. The authors recorded each patient's pain scores and measured his or her vital signs at the emergency department triage desk. After discharge, the authors attached the patient's diagnosis. The authors only evaluated patients with a verifiable painful diagnosis such as a kidney stone, myocardial infarction, small bowel obstruction, fracture, burn, crush injury, stab wound, amputation, corneal abrasion and dislocation. The authors excluded non-verifiable conditions such as back pain and headache.
Of the 1,063 patients that participated in this study, the most common diagnoses were kidney stone (25%) and fracture (23%). The average triage pain score was seven. The average heart rate was 85 beats per minute. The systolic blood pressure was 141, and the respiratory rate was 19 breaths per minute.
The authors concluded that there was no clinically significant association between self-reported triage pain scores and heart rate, blood pressure or respiratory rate.
The Street
As most of you know, I'm a big proponent of aggressive treatment of pain in the prehospital environment. I must admit that sometimes I roll my eyes when a patient with a small cut rates his or her pain at a 12 on a scale of 10. To me a 10 would be a hot lava enema! I just chalk it up to a lack of a vivid imagination on the part of our patients.
With that said, I have also heard health-care providers say, "Well, he can't be in much pain because he isn't even tachycardic." This study is a milestone in my book to the fact that every patient's pain is theirs and theirs alone. We have created so many myths and personal biases regarding pain that it gets in the way of caring for our patients. Our traditional teaching has been so ingrained in us with these myths that when we don't see the expected changes in vital signs, we assume the patient is simply not in as much pain as they profess.
It may be true that if your patient is tachycardic, tachypneic or hypertensive that it could be a reflection of his or her degree of pain. This is useful when you have the stoic patient who refuses to confess how much it hurts. However, the converse is not true, as it was eloquently demonstrated in this study.
Remember: Our job is not to keep the patients from becoming junkies. It's to provide compassionate care and relieve pain and suffering. Leave the prejudice to someone less enlightened than you.
