The Incidence, Impact and Experience of Pain in Recently Discharged Adult Trauma Patients: A Convergent Parallel Mixed Methods Study

Abstract

Introduction Despite being given ‘take-home’ analgesics and hospital discharge information, trauma patients frequently report pain at moderate to severe levels at home. Patients who have inadequate pain relief following injury can experience a delayed return to work, psychological stress, disability and chronic pain. Aim The aim of this thesis was to investigate the pain and pain management experiences of recently discharged adult trauma patients and to generate evidence to inform future interventions to improve pain management in this population. Methods A convergent parallel mixed methods study was conducted. Eighty-two participants completed questionnaires, medical records were reviewed and 12 semi-structured interviews were performed. Descriptive statistics were used for quantitative data analysis. Qualitative data were thematically analysed. Quantitative and qualitative data were then integrated to produce greater understanding of, and explanation for, the pain management practices of recently discharged adult trauma patients and to inform the recommendations from this research. Results The mean age of participants was 52 years (SD = 19.8), of which 54 (66%) were males. Approximately half of the participants (n = 43, 52%) had an Injury Severity Score (ISS) < 9, with two or three body regions typically injured. Participants were seen in the trauma outpatient clinic 16 days (IQR 14 − 23) after hospital discharge, with the majority of them reporting pain since discharge (n = 80, 98%). Injury pain was common, intense and debilitating and hospital discharge information and ‘take-home’ analgesics were inadequate. The trauma patients wanted to manage their pain independently at home; however, without sufficient knowledge or understanding about their injury trajectory and pain management, they did not have the confidence to do so. Conclusion Improved hospital discharge processes and specific injury discharge information and education are recommended to enhance the trauma patient’s understanding of the injury trajectory and their pain management practices. Better organisational processes, and information and education about pain and injury could facilitate the appropriate use of analgesics at home and improve the management of injury related pain.