Analgesic Adherence in Recently Discharged Trauma Patients

An Integrative Literature Review

Helen Goldsmith, RN, PhD Candidate; Kate Curtis, RN, PhD; Andrea McCloughen, RN, PhD

Disclosures

Pain Manag Nurs. 2016;17(1):63-79. 

In This Article

Abstract and Introduction

Abstract

Trauma is defined as injuries to tissue and organs resulting from mechanical, thermal, chemical, or electrical mechanisms. There is evidence to suggest that patients admitted to hospital for their injuries do not adhere to prescribed analgesic regimens once discharged; however, the causes and potential solutions of this have not been fully explored. Patients who have inadequate pain relief also experience delayed return to work, psychological stress, disability, and chronic pain.

Objectives: To identify causes of and solutions to analgesic regimen nonadherence in recently discharged trauma patients.

Design: Integrative literature review.

Data Sources: A systematic search using electronic databases (PsycINFO; Embase; CINAHL; Medline) and hand-searching methods, using the terms "analgesics," "pain," "trauma," and "discharge," was conducted for the period 1990 to 2014.

Review/Analysis Methods: Following a systematic screening process, the included articles were analyzed and synthesized to identify patterns, variations, and relationships.

Results: Twenty-four primary research articles were examined and three main categories were identified: pain is a common and enduring experience in recently discharged trauma patients, postdischarge analgesics are inadequately prescribed and poorly used, and inadequate discharge information inhibits adequate analgesic use.

Conclusion: Reasons for poor analgesic adherence in the trauma outpatient population are not well understood and there is a paucity of solutions to address this problem. Research to inform the design of an evidence-based patient discharge process and patient information tools would address this evidence-practice gap.

Introduction

More than 5.8 million people worldwide die each year from traumatic injuries, and many more are left to endure the physical and emotional consequences of such an event (World Health Organisation, 2014). Trauma is defined as injury to tissue and organs resulting from the transfer of energy from the environment. Injuries result when a form of energy (i.e., mechanical, thermal, chemical, electric) is beyond the body's resilience to tolerate. The type and severity of injuries depend on the anatomical structures affected, amount and type of energy applied, and mechanism of injury (Alpen & Morse, 2001). Examples of mechanisms of injury include motor vehicle collision, pedestrian and cyclist impacts, falls, and burns. Injuries that occur simultaneously to multiple parts of the body are referred to as polytrauma (Gebhard & Huber-Lang, 2008).

Traumatic injuries can result in significant acute pain, as damage to the body's tissues and nerves can cause nociceptive and/or neuropathic discomfort (Keene, Rea, & Aldington, 2011). Analgesia does not simply make patients feel better, but assists in early ambulation and adequate oxygenation and nutrition; in doing so, it also reduces the stress response to surgery, encourages wound healing, and minimizes the risk of developing chronic wound pain (Pediani, 2001). Patients report that they are generally satisfied with how their pain is managed during their hospital stay; however, at hospital discharge, many patients report pain (Archer, Castillo, Wegener, Abraham, & Obremskey, 2012; Berben et al., 2008) and within 2 weeks of discharge, trauma patients continue to experience pain at moderate to severe levels (Au & Holdgate, 2010; Newman and Halpern, 2007). These patients are unfortunately less likely to return to work; more likely to suffer from depression, posttraumatic stress disorder, and other psychological comorbidities; and report greater disability than trauma patients who report less pain (Sinha & Cohen 2011). There is some evidence to suggest that discharged patients do not adhere to prescribed analgesic regimens (Mcintosh and Leffler, 2004, Newman and Halpern, 2007); however, explanations for this have not been fully explored. Given the negative outcomes associated with poor pain management and the lack of inquiry about the characteristics of nonadherence among discharged trauma patients, there is a need for further research of this problem.

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