Prevalence of Chronic Pain After an Emergency Department Visit for Severe Acute Pain (CHROPAIN)

Prevalence of Chronic Pain After an Emergency Department Visit for Severe Acute Pain and Influence of the Analgesia Initially Used

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.

Study Overview

• Status: Completed
• Conditions: EMERGENCY MEDICINE

Detailed Description

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?

• Study Type: Observational
• Enrollment (Actual): 495

Contacts and Locations

Study Locations

• France
  • Bordeaux, France, 33000
    • CHU Pellegrin
  • Grenoble, France, 38000
    • Grenoble Alpes University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

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

Description

Inclusion Criteria:

• To 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;
• Initial pain ≥6 on the Numerical Pain Scale ;
• Acute pain that has been evolving for less than 7 days.
• No oral opposition of the subject required during the phone call

Exclusion Criteria:

• Patient who has undergone surgery in the direct course or within one month of the emergency department visit;
• Patient with suspected or confirmed coronary chest pain at the time of discharge from the emergency department;
• Patient with a mental disability;
• Patient dead;
• Patient who is deaf or hard of hearing;
• Patient who does not speak French or does not live in France
• Patient whose medical history was noted in the file as being impossible due to communication problems;
• Patient who left the emergency department before the end of medical care;
• Patient consulting for acutization of chronic pain;
• Patient during pregnancy;
• Patient consulting for a recent complication of care (within the month), surgical or other;
• Patient taking daily analgesic treatments in the last 2 months;
• Patient known to be dependent on opioids or treated with substitution therapy;
• Homeless patient;
• Patient who has been injured in the course of an assault or violence.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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.	6 month

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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.	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	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	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	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	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.	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.	6 month
Neuropathic characteristics of pain at 6 months	The neuropathic characteristics of pain will be characterized by the DN-4 questionnaire	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	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	6 month

Collaborators and Investigators

• Sponsor: University Hospital, Grenoble

Study record dates

Study Major Dates

• Study Start (Actual): December 5, 2020
• Primary Completion (Actual): September 1, 2021
• Study Completion (Actual): March 1, 2022

Study Registration Dates

• First Submitted: November 5, 2020
• First Submitted That Met QC Criteria: November 5, 2020
• First Posted (Actual): November 12, 2020

Study Record Updates

• Last Update Posted (Actual): May 24, 2022
• Last Update Submitted That Met QC Criteria: May 23, 2022
• Last Verified: May 1, 2022

More Information

Terms related to this study

• Keywords: emergency department; prevalence chronic pain; severe acute pain; initial analgesia
• Additional Relevant MeSH Terms: Pathologic Processes; Pain; Neurologic Manifestations; Disease Attributes; Emergencies; Chronic Pain; Acute Pain
• Other Study ID Numbers: 38RC20.293; 2020-A02317-32 (Other Identifier: ID RCB)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No