EM - ORIGINAL Factors influencing desired and received analgesia in emergency department Attilio Allione • Remo Melchio • Gianpiero Martini • Luca Dutto • Marco Ricca • Emanuele Bernardi • Fulvio Pomero • Valentino Menardo • Bruno Tartaglino Received: 14 March 2010 / Accepted: 9 September 2010 / Published online: 29 September 2010 Ó SIMI 2010 Abstract Oligoanalgesia in Emergency Departments (ED) is known to be common. The aim of our study is to determine how often patients in pain desire and receive analgesics while in the ED. Four main outcomes have been considered: desire of analgesics, administration of analge- sics in the ED, correlation between initial analgesic administration and triage priority scores, patients’ satis- faction at discharge during the ED visit. Pain severity was evaluated by a 10-point numerical rating scale (0 = no pain, 10 = worst possible pain) A total of 393 patients were enrolled in the study. The majority were non-Hispanic whites with a median age of 62 years. Of the 393 patients, 202 expressed desire for analgesics, but only 146 received a treatment. Among patients refusing analgesics (48.6%), the most common reasons were to diagnose pain causes and pain tolerance. In multivariate analysis, pain score severity was significant factor that predicted wanting analgesics, whereas desiring analgesics was predictive factor to receive them. On the other hand, patients with pain localized in lower extremities and in nose or ear less probably received analgesia. In conclusion, the underuse of analgesics in the ED continues to represent a problem and our study demonstrates that half of all ED patients in pain desire analgesics and that only half of those wanting analgesics receive them. Patients that desired and received analgesic treatment represented the group with a higher degree of satisfaction. Keywords Oligoanalgesia Á Emergency department Á Pain assessment Á Pain desire Introduction Wilson and Pendleton [1] coined the term ‘‘oligoanalgesia’’ to describe the failure in recognition and appropriate treatment of pain. Some studies have shown that up to 70% of patients visiting Emergency Departments (ED) declare pain, but receive an inadequate analgesia in a large pro- portion [2, 3]. In the North American setting, the main factors associ- ated with oligoanalgesia include older age, ethnicity, providers’ perceptions of patients’ pain, and crowding [4–6]. The Joint Commission [7] and the Veterans Health Administration [8] show that an inaccurate or a missing assessment of patients’ pain is a major predictor of insuf- ficient pain treatment. The triage nurse is usually the first health-care provider to assess pain among ED patients, and assessment at triage represents a critical step in the timeliness of the analgesic administration. Drug administration, opiate analgesia, time of adminis- tration, prescription therapy at discharge have been con- sidered to be good analgesia indicators [3–10]. Nevertheless, many patients admitted to the ED with pain do not desire analgesics. Singer et al. [11] defined analgesia to be inadequate when patients desire analgesics and do not receive them in the absence of contraindications. A. Allione (&) Á R. Melchio Á G. Martini Á L. Dutto Á M. Ricca Á E. Bernardi Á F. Pomero Á V. Menardo Á B. Tartaglino Department of Emergency, Azienda Ospedaliera S. Croce e Carle, Via Michele Coppino, 12100 Cuneo, Italy e-mail: allione.attilio@libero.it 123 Intern Emerg Med (2011) 6:69–78 DOI 10.1007/s11739-010-0463-9