Comparison of multimodal, sliding scale acute pain protocols with traditional prescribing in non-surgical patients

ABSTRACT

Objective: Our institution implemented six multimodal, sliding scale protocols for managing pain in non-surgical inpatients. The purpose of this study was to compare the use of these acute pain protocols with traditional prescribing in regard to pain management efficacy and safety measures.

Methods: This retrospective cohort study evaluated hospital in-patients who were prescribed one of the protocols during the first 6 months following implementation, admitted to the hospitalist service, and had received at least two doses of PRN analgesic medication within a 24-hour period. Data collected included baseline demographics, verbal pain rating scores to determine time to achieve analgesia, total opioid use in oral morphine equivalent doses (MEDs), and safety measures. A sample of patients admitted during the same time frame, meeting inclusion/exclusion criteria, but who received traditional analgesic prescribing served as controls.

Results: Forty-six adult, non-surgical patients were included in the analysis, and 46 served as controls. The average baseline pain scores were similar between groups (7.26 in protocol, 7.43 in control, p = 0.684). Protocol patients required significantly less time to achieve meaningful analgesia (average 507.52 min) compared to the control group (894.33 min, p = 0.045). Patients in the protocol group used an average of 35.81 MEDs per day compared to 65.77 MEDs in controls (p = 0.019). Patients in the protocol group used significantly fewer PRN analgesic doses (12.70 vs. 24.02, p < 0.0001).

Conclusion: Analysis of the implementation of acute pain management protocols indicates that using standardized pain management protocols of opioids, non-opioids, and medications to prevent opioid-related adverse events is more effective than traditional analgesic prescribing for our patient population.

KEYWORDS:

• Multimodal analgesia
• acute pain
• protocol
• inpatient
• general medicine

Contribution statement

Contributions to this manuscript were made while this author was a student at the University of Rhode Island College of Pharmacy.

Declaration of funding

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

Dr. Pawasauskas has previously been a paid consultant and speakers’ bureau member for Mallinckrodt Pharmaceuticals.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data Sharing

The data that support the findings of this study are available from the corresponding author, JP, upon reasonable request.

Declaration of interest

Jayne Pawasauskas is a consultant for Mallinckrodt Pharmaceuticals and Heron Therapeutics.