An observational study in EMERGENCY MEDICINE, sponsored by University Hospital, Grenoble. Completed at 2 sites in France. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2022-05-24.
Sponsored by University Hospital, Grenoble · Observational
The main objective for investigators is to determine the prevalence of moderate to severe chronic pain in the adult population 6 months after consultation in the emergency department for acute pain (less than 7 days old) and severe pain assessed at admission and defined as greater than or equal to 6/10 by the numerical pain scale.
The presence of pain is the most frequent reason for a patient to visit the emergency department. the investigators know that severe acute pain can be a risk factor for developing chronic pain.
Chronic pain is a symptom, devoid of biological utility, that persists despite the absence of nociceptive stimulus, even after a reasonable period of time that would have allowed the tissue lesion to heal. It is therefore a public health problem with a negative impact on patients' lives.
Chronic pain has been studied in anesthesia and surgery in recent years. In 2006, a study showed the appearance of chronic pain (incidence between 10-50%) in patients who had undergone routine surgery. On the other hand, few studies have looked at the occurrence of chronic pain in patients who came to the emergency department for acute pain.
It is in this context that the investigators find it relevant to assess the prevalence of moderate to severe chronic pain after an emergency department consultation for severe acute pain.
The physiological mechanisms of pain are better identified and the activation of N-methyl-D-aspartate (NMDA) receptors contributes to the onset of hyperalgesia. These receptors are activated under certain conditions, such as during intense and prolonged pain or exposure to high doses of opioids. In addition, the hyperalgesic effect of opioids is known and widely described in the literature. Finally, in the perioperative period, it is now accepted that the administration of a low dose of ketamine can combat these hyperalgesic effects thanks to its NMDA receptor inhibitory action. This effect may have an impact on pain at six months after surgery.
On the basis of these data, it seems relevant to question the prevalence of chronic pain in the course of an emergency department consultation, all the more so in patients with severe initial pain, in whom there is an initial indication for morphine titration, based on the recommendations of the French Society of Emergency Medicine (SFMU).
In addition, the investigators need to question the effects of initial analgesia administered in the emergency department for patients with severe acute pain. Is there a link between the use of certain molecules or the combination of molecules on the onset of chronic pain?
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Patient who have consulted in the emergency department between 4 to 5 months before reading the files to be contacted 6 months after the consultation in the emergency department
Exclusion Criteria:
Determine prevalence of moderate to severe chronic pain in adult population 6 months after consultation in the emergency department for acute pain (less than 7 days old) and severe pain assessed at admission (defined ≥6/10 by the numerical pain scale)
The main judgment criteria is the presence of chronic pain, related to the pain that motivated the emergency department visit 6 months earlier, moderate to severe defined as pain evolving since the emergency department visit (6 months), experienced at least 2 times per week, and of intensity ≥ 4 on a numerical pain scale during the patient's last painful experience.
Time frame: 6 month
To compare the prevalence of chronic pain in patients who initially consulted for pain of traumatic or non-traumatic origin.
Compare the prevalence of moderate to severe chronic pain (defined in the primary end point ≥4/10) in the group of patients who initially consulted for pain from traumatic and nontraumatic causes. Traumatic pain is defined as pain related to a traumatic mechanism less than 1 week old.
Time frame: 6 month
Evaluate whether there is an association between the prevalence of chronic pain at 6 months and pain management in use of analgesic, which molecule when the patient goes to the emergency department ;
Association between the prevalence of chronic pain and pain management in the emergency department at analgesic treatment used per molecule
Time frame: 6 month
Evaluate whether there is an association between the prevalence of chronic pain at 6 months and pain management in use of analgesic at which dose when the patient goes to the emergency department ;
Association between the prevalence of chronic pain and pain management in the emergency department at the total dose administered to the emergency department
Time frame: 6 month
Evaluate whether there is an association between the prevalence of chronic pain at 6 months and pain management at the performance of a locoregional anaesthesia when the patient goes to the emergency department ;
Association between the prevalence of chronic pain and pain management in the emergency department in the realization of a locoregional anaesthesia
Time frame: 6 month
Evaluate whether there is an association between the prevalence of chronic pain at 6 months and pain management at the performance of sedation when the patient goes to the emergency department ;
Association between the prevalence of chronic pain and pain management in the emergency department in the performance of procedural sedation
Time frame: 6 month
If patients with chronic pain at 6 months reconstructed more often than patients without chronic pain
We will assess whether patients with chronic pain at 6 months reconstruct more often than patients without chronic pain by asking them whether or not they consulted a list of medical specialists, paramedics or did other tests.
Time frame: 6 month
The type, characteristics and impact of pain at 6 months after admission to the emergency department.
Brief Pain Inventory Short Form (BPI-SF) questionnaire, 6 months after their visit to the emergency department.
Time frame: 6 month
Neuropathic characteristics of pain at 6 months
The neuropathic characteristics of pain will be characterized by the DN-4 questionnaire
Time frame: 6 month
Quality of life 6 months after admission to the emergency department
The SF-12 questionnaire will assess quality of life 6 months after admission to the emergency department
Time frame: 6 month
Analgesic treatment at 6 months.
Analgesic treatment at 6 months will be evaluated by asking the patient his usual analgesic treatment by class of molecule
Time frame: 6 month
Plan to share: No
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University Hospital, Grenoble