We hypothesize (based on literature) that the incidence of chronic pain in The Netherlands is around 15-20% in patients presenting to the emergency department with (acute) pain related complaints. We have no further hypothesis, because of the…
ID
Source
Brief title
Condition
- Fractures
Health condition
Chronic pain Acute pain Emergency deparment Prediction model Factors of influence Predictors Netherlands Acute pijn Chronische pijn Spoedeisende Hulp Predictie model Voorspellend model Factoren van invloed Predictoren Nederland
Research involving
Sponsors and support
Intervention
- Other intervention
Outcome measures
Primary outcome
Secondary outcome
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Background summary
Pain is one of the most common presenting complaints in an Emergency Department (ED). Nevertheless, undertreatment of this pain remains a problem. The consequence of undertreatment of patients with acute pain could be the transitioning into chronic pain. Chronic pain, defined as pain lasting for more than 3 months, is an important cause of healthcare (over)utilization. The incidence of chronic pain is still unknown, yet the prevalence is estimated to be 18% in The Netherlands. Until now, studies have focused on the treatment of acute pain on an emergency department and on identifying the risk factors for developing chronic pain. Differentiating patients at risk of developing chronic pain in an early stage can help prevent chronification as these patients can receive efficient and adapted treatment at an earlier stage. To our knowledge there were a few initiatives towards the development of a prediction model to distinguish patients in an early stage whom have an increased risk of developing chronic pain. However, those studies only determined the risk factors for the development of chronic pain in specific groups of patients.
Objective: To develop a prediction model to distinguish patients with an increased risk of developing chronic pain in an early – acute pain- stage and target them to efficient and adapted treatment to prevent the development of chronic pain.
Study design: Prospective multicenter longitudinal study
Study population: Patients 18 years and older who presented to the ED for a pain related cause and are not hospitalized.
During the first 7 consecutive days after visiting the ED, after 90 and 180 days patients will be asked to complete a short questionnaire using a specifically developed electronic application. The questionnaires will concern questions about general health, quality of life and pain. The first period of the trial, for the duration of 1 month, traditional paper questionnaires will be used to compare response rate between the web-based electronic survey and paper questionnaires.
Study objective
We hypothesize (based on literature) that the incidence of chronic pain in The Netherlands is around 15-20% in patients presenting to the emergency department with (acute) pain related complaints.
We have no further hypothesis, because of the observational aspect of our study. The list of candidate predictors for the development of chronic pain is based on a literature search in 2018.
Study design
1st August
Start period 1 ( Start with paper questionnaires in Franciscus Gasthuis & Vlietland)
1st September
Continuation of period 1 (Start with electronical questionaires in Franciscus Gasthuis & Vlietland)
End of paper questionnaires
1st October
Stop with period 1
Start with period 2 (inclusion in all hospitals with electronic questionnaires)
January 2019 Introduction first article
February 2019 Methods first article
March 2019 Interim analysis & start syntax
April 2019
1st May 2019 END of inclusion period in all hospitals
June 2019 Statistical analysis
July 2019 Statistical analysis
August 2019 Finalize article
September 2019 Finalize article
October 2019 Finalize article
Intervention
No interventions
Age
Inclusion criteria
* Age > 17 years, both sexes (adult patients).
* Acute Pain, existing < 48 hours as main complaint during ED visit
* Discharged after initial ED treatment
* Signed written informed consent
Exclusion criteria
* Cognitive impairment
* Illiteracy
* Language barrier
* Current diagnosis of chronic pain if located on or near the location of their current complaint
* Acute pain within 7 days after surgery
* Hospital admission
Design
Recruitment
IPD sharing statement
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| NTR-new | NL7079 |
| NTR-old | NTR7277 |
| Other | : 2018-39 |
Summary results
borderline statistically significant with an odds ratio of 1.45 (95% confidence interval: 0.99–2.13, P 5 0.054). Various sensitivity analyses using a different (V)NRS at discharge and different definitions of chronic pain at 90 days showed a significant difference in the chronification of pain.
Conclusion: This study suggests that pain intensity at discharge from the ED, regardless of the localization or cause of pain,
increased the risk of developing chronic pain. By distinguishing patients at risk and providing an effective treatment, chronic pain
and the associated burden of disease might be preventable. "