Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

CiteScore 2018: 0.85

SCImago Journal Rank (SJR) 2018: 0.494
Source Normalized Impact per Paper (SNIP) 2018: 0.427

See all formats and pricing
More options …
Volume 15, Issue 1


Acute pain in the emergency department: Effect of an educational intervention

Kristian Dahl Friesgaard / Charlotte Paltved / Lone Nikolajsen
  • Danish Pain Research Center Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
  • Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-04-01 | DOI: https://doi.org/10.1016/j.sjpain.2016.11.004


Background and aims

Pain management is often inadequate in emergency departments (ED) despite the availability of effective analgesics. Interventions to change professional behavior may therefore help to improve the management of pain within the ED. We hypothesized that a 2-h educational intervention combining e-learning and simulation would result in improved pain treatment of ED patients with pain.


Data were collected at the ED of Horsens Regional Hospital during a 3-week study period in March 2015. Pain intensity (NRS, 0–10) and analgesic administration were recorded 24 h a day for all patients who were admitted to the ED during the first and third study weeks. Fifty-three ED nurses and 14 ED residents participated in the educational intervention, which took place in the second study week.


In total, 247 of 796 patients had pain >3 on the NRS at the admission to the ED and were included in the data analysis. The theoretical knowledge of pain management among nurses and residents increased as assessed by a multiple choice test performed before and after the educational intervention (P = 0.001), but no change in clinical practice could be observed: The administration for analgesics [OR: 1.79 (0.97–3.33)] and for opioids [2.02 (0.79–5.18)] were similar before and after the educational intervention, as was the rate of clinically meaningful pain reduction (NRS >2) during the ED stay [OR: 0.81 (CI 0.45–1.44)].


Conduction of a 2-h educational intervention combining interactive case-based e-learning with simulation-based training in an ED setting was feasible with a high participation rate of nurses and residents. Their knowledge of pain management increased after completion of the program, but transfer of the new knowledge into clinical practice could not be found. Future research should explore the effects of repeated education of healthcare providers on pain management.


It is essential for nurses and residents in emergency departments to have the basic theoretical and practical skills to treat acute pain properly. A modern approach including e-learning and simulation lead to increased knowledge of acute pain management. Further studies are needed to show how this increased knowledge is transferred into clinical practice.

Keywords: Emergency department; Acute pain; Education; e-Learning; Medical simulation


  • [1]

    Berben SA, Schoonhoven L, Meijs TH, van Vugt AB, van Grunsven PM. Prevalence and relief of pain in trauma patients in emergency medical services. Clin J Pain 2011;27:587–92.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [2]

    Todd KH, Ducharme J, Choiniere M, Crandall CS, Fosnocht DE, Homel P, Tanabe P. Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study. J Pain 2007;8:460–6.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [3]

    Cordell WH, Keene KK, Giles BK, Jones JB, Jones JH, Brizendine EJ. The high prevalence of pain in emergency medical care. Am J Emerg Med 2002;20:165–9.CrossrefPubMedGoogle Scholar

  • [4]

    Zohar Z, Eitan A, Halperin P, Stolero J, Hadid S, Shemer J, Zveibel FR. Pain relief in major trauma patients: an Israeli perspective. J Trauma 2001;51:767–72.CrossrefPubMedGoogle Scholar

  • [5]

    Rupp T, Delaney KA. Inadequate analgesia in emergency medicine. Ann Emerg Med 2004;43:494–503.PubMedCrossrefGoogle Scholar

  • [6]

    Pretorius A, Searle J, Marshall B. Barriers and enablers to emergency department nurses’ management of patients’ pain. Pain Manag Nurs 2015;16: 372–9.CrossrefWeb of SciencePubMedGoogle Scholar

  • [7]

    Todd KH, Sloan EP, Chen C, Eder S, Wamstad K. Survey of pain etiology, management practices and patient satisfaction in two urban emergency departments. CJEM 2002;4:252–6.CrossrefPubMedGoogle Scholar

  • [8]

    Motov SM, Khan AN. Problems and barriers of pain management in the emergency department: are we ever going to get better. J Pain Res 2008;2:5–11.PubMedGoogle Scholar

  • [9]

    Fosnocht DE, Swanson ER, Barton ED. Changing attitudes about pain and pain control in emergency medicine. Emerg Med Clin North Am 2005;23: 297–306.PubMedCrossrefGoogle Scholar

  • [10]

    Harting B, Abrams R, Hasler S, Odwazny R, McNutt R. Effects of training on a simulator of pain care on the quality of pain care for patients with cancer-related pain. Qual Manag Health Care 2008;17:200–3.PubMedCrossrefGoogle Scholar

  • [11]

    Decosterd I, Hugli O, Tamches E, Blanc C, Mouhsine E, Givel JC, Yersin B, Buclin T. Oligoanalgesia in the emergency department: short-term beneficial effects of an education program on acute pain. Ann Emerg Med 2007;50:462–71.Web of ScienceCrossrefPubMedGoogle Scholar

  • [12]

    Jones JB. Assessment of pain management skills in emergency medicine residents: the role of a pain education program. J Emerg Med 1999;17: 349–54.CrossrefPubMedGoogle Scholar

  • [13]

    Sampson FC, Goodacre SW, O’Cathain A. Interventions to improve the management of pain in emergency departments: systematic review and narrative synthesis. Emerg Med J 2014;31:9–18.Web of ScienceCrossrefGoogle Scholar

  • [14]

    Jackson SE. The efficacy of an educational intervention on documentation of pain management for the elderly patient with a hip fracture in the emergency department. J Emerg Nurs 2010;36:10–5.CrossrefWeb of SciencePubMedGoogle Scholar

  • [15]

    Jones JB. Assessment of pain management skills in emergency medicine residents: the role of a pain education program. J Emerg Med 1999;17:349–54.CrossrefPubMedGoogle Scholar

  • [16]

    Sucov A, Nathanson A, McCormick J, Proano L, Reinert SE, Jay G. Peer review and feedback can modify pain treatment patterns for Emergency Department patients with fractures. Am J Med Qual 2005;20:138–43.PubMedCrossrefGoogle Scholar

  • [17]

    Dror I, Schmidt P, O’Connor L. A cognitive perspective on technology enhanced learning in medical training: great opportunities, pitfalls and challenges. Med Teach 2011;33:291–6.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [18]

    Rosen MA, Salas E, Wu TS, Silvestri S, Lazzara EH, Lyons R, Weaver SJ, King HB. Promoting teamwork: an event-based approach to simulationbased teamwork training for emergency medicine residents. Acad Emerg Med 2008;15:1190–8.CrossrefGoogle Scholar

  • [19]

    Rudolph JW, Simon R, Raemer DB, Eppich WJ. Debriefing as formative assessment: closing performance gaps in medical education. Acad Emerg Med 2008;15:1010–6.Web of ScienceCrossrefPubMedGoogle Scholar

  • [20]

    Gammaitoni AR, Fine P, Alvarez N, McPherson ML, Bergmark S. Clinical application of opioid equianalgesic data. Clin J Pain 2003;19:286–97.CrossrefPubMedGoogle Scholar

  • [21]

    Dale J, Bjornsen LP. Assessment of pain in a Norwegian Emergency Department. Scand J Trauma Resusc Emerg Med 2015;23:86.CrossrefGoogle Scholar

  • [22]

    Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 2011;6:42.CrossrefPubMedWeb of ScienceGoogle Scholar

About the article

Department of Anesthesiology, Horsens Regional Hospital, Sundvej 30, 8700 Horsens, Denmark.

Received: 2016-09-16

Revised: 2016-11-11

Accepted: 2016-11-13

Published Online: 2017-04-01

Published in Print: 2017-04-01

Ethical issues: The local ethics committee of Central Denmark Region was consulted and they replied that ethical approval was not required for this study according to the Scientific Ethical Committees Act (section 14, subsection 1). Reference number 307/2014.

Conflicts of interest: The authors declare no conflicts of interest.

Funding: The Regional Postgraduate Medical Education Administration Office North and The Health Research Fund of Central Denmark Region funded this project.

Citation Information: Scandinavian Journal of Pain, Volume 15, Issue 1, Pages 8–13, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2016.11.004.

Export Citation

© 2016 Scandinavian Association for the Study of Pain.Get Permission

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

Mette Poulsenª, Kristian Dahl Friesgaard, Sophie Seidenfaden, Charlotte Paltved, and Lone Nikolajsen
Scandinavian Journal of Pain, 2019, Volume 19, Number 3, Page 619
Daniel Aiham Ghazali, Philippe Kenway, Richard Clery, Christophe Choquet, and Enrique Casalino
Contemporary Clinical Trials Communications, 2019, Volume 14, Page 100331

Comments (0)

Please log in or register to comment.
Log in