Semiological evaluation of pain according to its origin: a prospective, observational, and national study of current French medical practice

Abstract

Objective:

To determine how the origin of acute pain influences its semiological characteristics, and to evaluate the efficacy and safety of two Level 2 analgesic combinations in general practice.

Research design and methods:

This prospective, observational, multicenter study enrolled patients who consulted general practitioners across France for intense pain that lasted ≥7 days and for which the physician prescribed paracetamol–codeine or paracetamol–tramadol. Completed physician (Day 0) and patient (Days 0–3 and Days 4–7) questionnaires provided data on the origin, characteristics, impact, and treatment of the pain, during the 7 days after the initial consultation.

Main outcome measures:

Pain intensity (0–10 unidimensional numerical scale), type (SF-MPQ) and impact on quality of life (QoL; SF-12).

Results:

Overall, 1003 patient questionnaires were completed for Days 0–3 and 941 for Days 4–7. The origin of pain was most commonly disease or trauma. Mean baseline pain intensity was 7 (SD 1.3; 0–10 numerical rating scale), and was similar regardless of the origin. The time-course of pain differed according to its origin: more than two-thirds of patients with trauma/work accident related pain described it as being constant, whereas 43% of those with disease-related pain described it as recurrent/intermittent. The origin of pain also influenced its QoL impact: trauma/work accident related pain led to functional and/or professional temporary incapacity in 77% and 83% of patients (vs 63% for disease-related pain), while disease-related pain led to a change in mood and/or feeling of anxiety in 79% of patients (vs 47% [trauma] and 58% [work accident related]). Both paracetamol–codeine and paracetamol–tramadol reduced pain intensity by approximately 75% and were well tolerated. Key limitations relate to the observational study design, countered by advantages gained from the ‘real life’ evaluation of acute pain and its treatment in a general medical practice setting.

Conclusions:

Acute pain should not be understood as a single entity but as multiple entities with specific characteristics related to its underlying origin. Furthermore, our data suggest that, as already demonstrated in clinical trials, Level 2 analgesia provides effective relief of acute pain in ‘real life’ conditions.

Keywords::

• Acute pain
• Etiology
• Pain
• Pain intensity
• Paracetamol
• codeine
• Paracetamol
• tramadol

Transparency

Declaration of funding

This study was funded by Pierre Fabre.

Declaration of financial/other relationships

P.B. has disclosed that he has no significant relationships with or financial interests in any commercial companies related to this study or article. C.T. has disclosed that he is an employee of Pierre Fabre.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

The authors thank David P. Figgitt PhD, Content Ed Net, for providing editorial support; funding for editorial support was provided by Pierre Fabre. The authors also thank Laetitia Finzi, ClinSearch, France, for her valuable collaboration in the synthesis of the results of this work.