PAIN AND SATISFACTION WITH PAIN CONTROL IN SERIOUSLY ILL HOSPITALIZEDADULTS - FINDINGS FROM THE SUPPORT RESEARCH INVESTIGATIONS

Objectives: To evaluate the pain experience of seriously ill hospitali zed patients and their satisfaction with control of pain during hospit alization. To understand the relationship of lever of pain and dissati sfaction with pain control to demographic, psychological, and illness- related variables. Design: Prospective, cohort study. Setting: Five te aching hospitals. Patients: Patients for whom interviews were availabl e about pain (n = 5,176) from a total of 9,105 patients in the Study t o Understand Prognoses and Preferences for Outcomes and Risks of Treat ments (SUPPORT). Interventions: None. Measurements and Main Results: P atients were interviewed after study enrollment about their experience s with pain. When patients could not be interviewed due to illness, we used surrogate (usually a family member) responses calibrated to pati ent responses (from the subset of interviews with both patient and sur rogate responses). Ordinal logistic regression was used to study the a ssociation of Variables with level of pain and satisfaction with its c ontrol. Nearly 50% of patients reported pain. Nearly 15% reported extr emely severe pain or moderately severe pain occurring at least half of the time, and nearly 15% of those patients with pain were dissatisfie d with its control. After adjustment for confounding variables, older and sicker patients reported less pain, while patients with more depen dencies in activities of daily living, more comorbid conditions, more depression, more anxiety, and poor quality of life reported more pain. Patients with colon cancer reported more pain than patients in other disease categories. Levels of reported pain varied among the five hosp itals and also by physician specialty. After adjustment for confoundin g variables, dissatisfaction with pain control was more likely among p atients with more severe pain, greater anxiety, depression, and altera tion of mental status, and lower reported income; dissatisfaction with pain control also varied among study hospitals and by physician speci alty. Conclusions: Pain is common among severely ill hospitalized pati ents. The most important variables associated with pain and satisfacti on with pain control were patient demographics and those Variables tha t reflected the acute illness. Pain and satisfaction with pain control Varied significantly among study sites, even after adjustment for man y potential confounders. Better pain management strategies are needed for patients with the serious and common illnesses studied in SUPPORT.