A Study On Comparison Of Pain Score Between Upper Limb And Lower Limb Fractures

##plugins.themes.bootstrap3.article.main##

  •   Kamarul Aryffin Baharuddin

  •   Mohd Hashairi Fauzi

  •   Mohd Faiz Mohd Shukri

  •   Normalinda Yaacob

  •   Mimi Azliha Abu Bakar

Abstract

Introduction: Pain is the most common chief complaint of patients presenting to Emergency Department (ED). Pain is not simply a signal for tissue injury, but also a signal to seek repair and recuperation. The aim of this study was to determine whether upper limb (UL) or lower limb (LL) fracture has more pain and to evaluate the association between types of fracture (UL vs LL) with adequacy of pain relief.


Methodology: A study was conducted from July to October 2005 in ED, Hospital Universiti Sains Malaysia (HUSM). Patients who fulfill the inclusion criteria were selected. Paramedics in charged were the assistants; at the same time became the observer. The paramedics were not involved in the decision making for pain management. Pain severity score was assessed by using Numeric Rating Scale (NRS).


Results: 42 patients were enrolled. 85.7% (n=36) were male and 14.3% were female. Mean age is 29.6 years old. Mean NRS on arrival for UL and LL fractures were 6.47 ± 1.70 and 7.80 ± 2.53 respectively. Mean NRS for mixed fractures (both UL and LL) was 7.60 ± 3.36. There was no statistically significant association between fracture sites and analgesic administration (p value=0.300). There were 70.6% and 70.0% of the patients with UL and LL fractures had adequate pain relief whereas 80% of patients with mixed fractures had adequate pain relief (p value= 0.902).


Conclusion: LL and mixed fractures had more pain score on arrival but there was no statistically significant association between fracture sites and analgesics administration and no association between fracture sites with adequacy of pain relief.


Keywords: fracture pain, upper limb, lower limb, pain relief

References

Ducharme, J. (2000). Acute pain and pain control: state of the art. Annals of Emergency Medicine, 35(6), 592-603.

Dale, J., & Bjørnsen, L. P. (2015). Assessment of pain in a Norwegian Emergency Department. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 23(1), 86.

Apley A.G, Solomon L. System of Orthopaedics and Fractures. Seventh Edition. ELBS.1993.

Santy, J., & Mackintosh, C. (2001). A phenomenological study of pain following fractured shaft of femur. Journal of Clinical Nursing, 10(4), 521-527.

Alves, C. J., Neto, E., Sousa, D. M., Leitao, L., Vasconcelos, D. M., Ribeiro-Silva, M., & Lamghari, M. (2016). Fracture pain—traveling unknown pathways. Bone, 85, 107-114.

Court-Brown, C. M., & Caesar, B. (2006). Epidemiology of adult fractures: a review. Injury, 37(8), 691-697.

Brown, JC., Klein, EJ., Lewis, CW., Johnston, BD., & Cummings, P. (2003). Emergency department analgesia for fracture pain. Annals of Emergency Medicine, 42(2), 197-205.

Cheng, J. (2018). State of the art, challenges, and opportunities for pain medicine. Pain Medicine, 19(6), 1109-1111.

Pines JM, Perron AD. Oligoanalgesia in ED patients with isolated extremity injury without documented fracture. Am J Emerg Med. 2005; 23(4): 58.

Baharuddin, K.A., Rahman, NHN., Wahab, SFA., Halim, NA., & Ahmad, R. (2014). Intravenous parecoxib sodium as an analgesic alternative to morphine in acute trauma pain in the emergency department. International Journal of Emergency Medicine, 7(1), 2.

Sluys, K. P., Shults, J., & Richmond, T. S. (2016). Health related quality of life and return to work after minor extremity injuries: A longitudinal study comparing upper versus lower extremity injuries. Injury, 47(4), 824-831.

Kendrick DB, Strout TD. The minimum clinically significant difference in patient-assigned numeric scores for pain. American Journal of Emergency Medicines. 2005; 23: 828-832.

Bijur PE, Latimer CT, Gallagher EJ. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Acad Emerg Med. 2003; 10: 390-392.

Strout TD, Burton JH. Clinically significant change in physician assigned numeric pain rating scores. Am J Emerg Med. 2004; 22: 243-245.

Fosnocht DE, Swanson ER, Barton ED. Changing attitudes about pain and pain control in Emergency Medicine. Emerg Med Clin N Am. 2005; 23: 297-306.

Mohammed, A. A., Ambak, K., Mosa, A. M., & Syamsunur, D. (2019). A review of the traffic accidents and related practices worldwide. The Open Transportation Journal, 13(1).

Sherman ED, Robillard E. Sensitivity to pain in relationship to age. J Am Geriatr Soc.1964; 12: 1037.

Li SF. Effect of age on acute pain perception of a standardized stimulus in the emergency department. Ann Emerg Med. 2001; 38(6): 644-7.

El Tumi, H., Johnson, M. I., Dantas, P. B. F., Maynard, M. J., & Tashani, O. A. (2017). Age‐related changes in pain sensitivity in healthy humans: A systematic review with meta‐analysis. European Journal of Pain, 21(6), 955-964.

Awasthi, B., Raina, S. K., Kumar, N., Sharma, V., Kalia, S., & Thakur, L. (2016). Pattern of extremity fractures among patients with musculoskeletal injuries: a hospital based study from North India. Journal of Medical Society, 30(1), 35.

Meena RK, Singh AM, Singh CA, Chishti S, Kumar AG, Langshon R. Pattern of fractures and dislocations in a tertiary hospital in North East India. Int J Epidemiol 2013;11:13-5.

Abdolrazaghnejad, A., Banaie, M., Tavakoli, N., Safdari, M., & Rajabpour-Sanati, A. (2018). Pain management in the emergency department: a review article on options and methods. Advanced Journal of Emergency Medicine, 2(4).

Thomas, S. H. (2013). Management of pain in the emergency department. ISRN Emergency Medicine, 2013.

Cisewski, D. H., & Motov, S. M. (2019). Essential pharmacologic options for acute pain management in the emergency setting. Turkish journal of emergency medicine, 19(1), 1-11.

Pudner, R. (Ed.). (2005). Nursing the surgical patient. Elsevier Health Sciences.

Chan, A., Malhotra, C., Do, Y. K., Malhotra, R., & Østbye, T. (2011). Self reported pain severity among multiethnic older Singaporeans: Does adjusting for reporting heterogeneity matter?. European Journal of Pain, 15(10), 1094-1099.

Baharuddin, K. A., Mohamad, N., Rahman, N. H. N. A., Ahmad, R., & Him, N. A. S. N. (2010). Assessing patient pain scores in the emergency department. The Malaysian Journal of Medical Sciences: MJMS, 17(1), 17.

Todd, K. H. (1996). Clinical versus statistical significance in the assessment of pain relief. Annals of emergency medicine, 27(4), 439-441.

Sokoloff, C., Daoust, R., Paquet, J., & Chauny, J. M. (2014). Is adequate pain relief and time to analgesia associated with emergency department length of stay? A retrospective study. BMJ open, 4(3), e004288.

Downloads

Download data is not yet available.

##plugins.themes.bootstrap3.article.details##

How to Cite
Baharuddin, K., Fauzi, M., Mohd Shukri, M. F., Yaacob, N., & Abu Bakar, M. A. (2020). A Study On Comparison Of Pain Score Between Upper Limb And Lower Limb Fractures. European Journal of Medical and Health Sciences, 2(3). https://doi.org/10.24018/ejmed.2020.2.3.267