Understanding the pain status of the patient: a survey of pain status and pain treatment in an orthopedic outpatient department

Background: Pain assessments help clinicians to evaluate their patients’ symptoms. However, patients’ satisfaction with pain management is difficult to interpret and may mislead the clinician into being satisfied with inadequate pain management.

Objective: We described and explored patients’ pain status, patients’ satisfaction with their pain management, the impact of pain on sleep habit and routine activities of daily living (ADLs), and the proportion of patients who had undertreatment of pain in the Orthopaedic Outpatient Department, Ramathibodi Hospital.

Methods: A prospective, cross-sectional survey study of pain characteristics and pain management of Orthopaedic outpatients aged over 18 years in the Orthopaedics Department, Ramathibodi Hospital using two parts of a verified questionnaire.

Results: In all, 863 patients were studied. Numbers of patients with acute or chronic pain were in similar proportions and mainly diagnosed as nociceptive pain (83.7%). Most of them suffered from moderate or severe pain (42.6% vs. 39.1%). Severity of symptoms was correlated with sleep disturbance and disturbance in ADLs. However, no correlation was revealed between satisfaction with pain management and the intensity of pain and there was also no correlation between satisfaction with pain management and sleep disturbance or disturbance in ADLs. Most commonly prescribed medications were nonsteroidal antiinflammatory drugs (NSAIDs) (58.8%). However, 93.4% of returning patients who suffered from severe pain were still treated with nonopioid analgesics.

Conclusion: Patients suffered from moderate to severe pain and had disturbances in their sleep habit and ADLs. Most of them were satisfied with previous pain management, which was usually with nonopioid analgesics including NSAIDs and muscle relaxants. This group included some patients who experienced a high intensity of pain. We recommend clinicians pay more attention to the pain intensity of individual patients and justify appropriate medication by using a step-up approach and multimodal analgesics