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No Such Thing as Low Risk

Chad T. Whelan, MD; Lei Jin, MS; David Meltzer, MD, PhD

Arch Intern Med. 2004;164:175-180.

Background  Pain is common in many populations of hospitalized patients. It is unknown if any populations of hospitalized patients are at low risk for pain. We studied the prevalence of pain and satisfaction with pain control in a general medicine inpatient service to determine if this population was at low risk for pain.

Methods  We performed a prospective cohort study of 5584 hospitalized patients. Pain and pain control were assessed in a follow-up telephone survey. Predictors of pain were determined through administrative databases and patient survey.

Results  Of the study patients, 59% had pain (28% reported severe, 19% moderate, and 12% mild pain). Among patients with common diagnoses, those with sickle cell crisis were the most likely and those with syncope were the least likely to report significant pain (90% and 34%, respectively). Patient characteristics significantly associated with increased pain included DRG (diagnosis related group) weight (odds ratio [OR], 1.19), Charlson Index score (OR, 1.03), age older than 65 years (OR, 0.65), female sex (OR, 1.17), and education level higher than high school (OR, 1.31). Pain was reported by 28% of patients without high-risk characteristics for pain; and 82.2% of patients were satisfied, 11.1% somewhat satisfied, and 6.7% dissatisfied with their pain treatment.

Conclusions  Pain was common in the study population and more patients rated their pain as severe than as moderate or mild. Pain was dispersed among diagnoses. Although most patients thought that their pain was adequately controlled, 18% of patients with pain (10% of all patients) reported that their pain was inadequately controlled. Although patient characteristics were associated with pain or dissatisfaction with pain control, they were weak predictors and significant pain was common even in populations at the lowest-risk for pain.

From the Department of Medicine (Drs Whelan and Meltzer and Ms Jin) and the School of Economics and Harris School of Public Policy Studies (Dr Meltzer), University of Chicago, Chicago, Ill. The authors have no relevant financial interest in this article.

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