Pain in the Emergency Department: Results of the Pain and Emergency Medicine Initiative (PEMI) Multicenter Study

Published:February 20, 2007DOI:


      Pain is the most common reason for emergency department (ED) use, and oligoanalgesia in this setting is known to be common. The Joint Commission on Accreditation of Healthcare Organizations has revised standards for pain management; however, the impact of these regulatory changes on ED pain management practice is unknown. This prospective, multicenter study assessed the current state of ED pain management practice. After informed consent, patients aged 8 years and older with presenting pain intensity scores of 4 or greater on an 11-point numerical rating scale completed structured interviews, and their medical records were abstracted. Eight hundred forty-two patients at 20 US and Canadian hospitals participated. On arrival, pain intensity was severe (median, 8/10). Pain assessments were noted in 83% of cases; however, reassessments were uncommon. Only 60% of patients received analgesics that were administered after lengthy delays (median, 90 minutes; range, 0 to 962 minutes), and 74% of patients were discharged in moderate to severe pain. Of patients not receiving analgesics, 42% desired them; however, only 31% of these patients voiced such requests. We conclude that ED pain intensity is high, analgesics are underutilized, and delays to treatment are common. Despite efforts to improve pain management practice, oligoanalgesia remains a problem for emergency medicine.


      Despite the frequency of pain in the emergency department, few studies have examined this phenomenon. This study documents high pain intensity and suboptimal pain management practices in a large multicenter ED network in the United States and Canada. These findings suggest that there is much room for improvement in this area.

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        • American College of Emergency Physicians
        Clinical policy: Critical issues in the evaluation and management of adult patients presenting with suspected acute myocardial infarction or unstable angina.
        Ann Emerg Med. 2000; 35: 521-544
        • American College of Emergency Physicians
        Clinical policy: Critical issues for the initial management and evaluation of patients presenting with a chief complaint of nontraumatic acute abdominal pain.
        Ann Emerg Med. 2000; 36: 406-415
        • American College of Emergency Physicians Board of Directors
        Policy Statement: Pain management in the emergency department.
        Ann Emerg Med. 2004; 44: 198
        • Bijur P.E.
        • Latimer C.T.
        • Gallagher E.J.
        Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department.
        Acad Emerg Med. 2003; 10: 390-392
        • Cordell W.H.
        • Keene K.K.
        • Giles B.K.
        • Jones J.B.
        • Jones J.H.
        • Brizendine E.J.
        The high prevalence of pain in emergency medical care.
        Am J Emerg Med. 2002; 20: 165-169
        • Ducharme J.
        • Barber C.
        A prospective blinded study on emergency pain assessment and therapy.
        J Emerg Med. 1995; 13: 571-575
        • Fry M.
        • Holdgate A.
        Nurse-initiated intravenous morphine in the emergency department: Efficacy, rate of adverse events and impact on time to analgesia.
        Emergency Medicine (Fremantle, WA). 2002; 14: 249-254
        • Gordon D.B.
        • Dahl J.L.
        • Miaskowski C.
        • McCarberg B.
        • Todd K.H.
        • Paice J.A.
        • Lipman A.G.
        • Bookbinder M.
        • Sanders S.H.
        • Turk D.C.
        • Carr D.B.
        American Pain Society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force.
        Arch Intern Med. 2005; 165: 1574-1580
        • Gordon D.B.
        • Pellino T.A.
        • Miaskowski C.
        • McNeill J.A.
        • Paice J.A.
        • Laferriere D.
        • Bookbinder M.A.
        A 10-year review of quality improvement in pain management: Recommendations for standardized outcome measures.
        Pain Management Nursing. 2002; 3: 116-130
        • Johnston C.C.
        • Gagnon A.J.
        • Fullerton L.
        • Common C.
        • Ladores M.
        • Forlini S.
        One-week survey of pain intensity on admission to and discharge from the emergency department: A pilot study.
        J Emerg Med. 1998; 16: 377-382
        • McCaig L.F.
        • Burt C.W.
        National Hospital Ambulatory Medical Care Survey: 2001 emergency department summary.
        Advance Data. 2003; 335: 1-29
        • Rupp T.
        • Delaney K.A.
        Inadequate analgesia in emergency medicine.
        Ann Emerg Med. 2004; 43: 494-503
        • Tanabe P.
        • Buschmann M.
        A prospective study of ED pain management practices and the patient’s perspective.
        J Emerg Nurs. 1999; 25: 171-177
        • Todd K.H.
        • Funk K.G.
        • Funk J.P.
        • Bonacci R.
        Clinical significance of reported changes in pain severity.
        Ann Emerg Med. 1996; 27: 485-489
        • Todd K.H.
        • Sloan E.P.
        • Chen C.
        • Eder S.
        • Wamstad K.
        Survey of pain etiology, management, and satisfaction in two urban emergency departments.
        Can J Emerg Med. 2002; 4: 252-256
        • Wilson J.E.
        • Pendleton J.M.
        Oligoanalgesia in the emergency department.
        Am J Emerg Med. 1989; 7: 620-623