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Open Access 25-04-2024 | Opioids | CE-Systematic reviews and meta-analysis

Multidimensional versus unidimensional pain scales for the assessment of analgesic requirement in the emergency department: a systematic review

Authors: Elena Crisman, Christian Appenzeller-Herzog, Senad Tabakovic, Christian Hans Nickel, Bruno Minotti

Published in: Internal and Emergency Medicine

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Abstract

Pain is a multidimensional experience, potentially rendering unidimensional pain scales inappropriate for assessment. Prior research highlighted their inadequacy as reliable indicators of analgesic requirement. This systematic review aimed to compare multidimensional with unidimensional pain scales in assessing analgesic requirements in the emergency department (ED). Embase, Medline, CINAHL, and PubMed Central were searched to identify ED studies utilizing both unidimensional and multidimensional pain scales. Primary outcome was desire for analgesia. Secondary outcomes were amount of administered analgesia and patient satisfaction. Two independent reviewers screened, assessed quality, and extracted data of eligible studies. We assessed risk of bias with the ROBINS-I tool and provide a descriptive summary. Out of 845 publications, none met primary outcome criteria. Three studies analyzed secondary outcomes. One study compared the multidimensional Defense and Veterans Pain Rating Scale (DVPRS) to the unidimensional Numerical Rating Scale (NRS) for opioid administration. DVPRS identified more patients with moderate instead of severe pain compared to the NRS. Therefore, the DVPRS might lead to a potential reduction in opioid administration for individuals who do not require it. Two studies assessing patient satisfaction favored the short forms (SF) of the Brief Pain Inventory (BPI) and McGill Pain Questionnaire (MPQ) over the Visual Analogue Scale (VAS) and the NRS. Limited heterogenous literature suggests that in the ED, a multidimensional pain scale (DVPRS), may better discriminate moderate and severe pain compared to a unidimensional pain scale (NRS). This potentially impacts analgesia, particularly when analgesic interventions rely on pain scores. Patients might prefer multidimensional pain scales (BPI-SF, MPQ-SF) over NRS or VAS for assessing their pain experience.
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Metadata
Title
Multidimensional versus unidimensional pain scales for the assessment of analgesic requirement in the emergency department: a systematic review
Authors
Elena Crisman
Christian Appenzeller-Herzog
Senad Tabakovic
Christian Hans Nickel
Bruno Minotti
Publication date
25-04-2024
Publisher
Springer International Publishing
Keywords
Opioids
Opioids
Published in
Internal and Emergency Medicine
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI
https://doi.org/10.1007/s11739-024-03608-5
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