Objectives: To evaluate patients' perceptions of the adequacy of analgesia for moderate-to-severe acute pain and the influence of opioid-related side effects in outpatient pain management.
Setting: The Physicians Partnering Against Pain (P3) survey of analgesic treatment for moderate-to-severe acute pain in the United States.
Patients: Adults with moderate-to-severe acute pain at their first analgesic followup visit.
Main outcome measures: Analgesic level was determined from the World Health Organization'spain ladder (0 = none; 1 = nonopioid; 2 = weak opioid; 3 = strong opioid). Pain intensity was derived from numeric rating scale (NRS) scores (0 = none [NRS = 0]; 1 = mild [NRS = 1-3]; 2 = moderate [NRS = 4-7]; 3 = severe [NRS = 8-10). Pain management index scores were calculated as the analgesic level minus the pain intensity. Opioid recipients responded to questions on the P3 survey regarding side effects and their management.
Results: Of the 50,869 patients with complete data for analysis, 22,267 (44 percent) had received potentially inadequate analgesia, including 43, 46, and 52 percent of patients aged < 65, 65-74, and > or = 75 years, respectively. Of the 39,6 75 patients treated with an opioid, 10,925 (28 percent) experienced at least one gastrointestinal side effect (nausea, vomiting or constipation). Many of these patients stopped taking the medication (13 percent) or reduced their dose (16 percent) to manage gastrointestinal side effects.
Conclusions: In the P3 study, one of the largest outpatient surveys conducted in pain management, moderate-to-severe acute pain continued to be widely undertreated in outpatient settings in the United States, particularly among older patients. Opioids with improved tolerability profiles might help to alleviate this undertreatment of moderate-to-severe acute pain.