PATIENT EMPOWERMENT AND FEEDBACK DID NOT DECREASE PAIN IN SERIOUSLY ILL HOSPITALIZED ADULTS

We tested a nurse clinician-mediated intervention to relieve pain in a group of seriously ill hospitalized adults using a randomized control led trial at five tertiary care academic centers in the US. The study included 4804 patients admitted between January 1992 and January 1994 with one or more of nine high mortality diagnoses; 2652 were allocated to the intervention and 2152 to usual care. Specially-trained nurse c linicians assessed patients' pain, educated them and their families ab out pain control, empowered patients to expect pain relief, informed p atients' nurses and physicians about level of pain and suggested or us ed other pain management resources, Patients' pain was determined from hospital interviews with patients and surrogates. Pain 2 and 6 months later or after death and satisfaction with its control at all time pe riods were also assessed. All analyses were adjusted for baseline risk of being in pain and propensity to be in the intervention group. Over all, 50.9% of patients reported some pain. After adjustment for other variables associated with pain, comparing the intervention to the cont rol group, there was not a statistically significant difference in lev el of pain (OR for higher levels of pain 1.15; CI 1.00-1.32) or satisf action with control of pain during the hospitalization (OR for higher levels of pain 1.12; CI 0.91-1.39), 2 or 6 months after discharge, or during the last 3 days of life, A multifaceted intervention using info rmation, empowerment, advocacy, counseling and feedback was ineffectiv e in ameliorating pain in seriously ill patients. Control of pain in t hese patients remains an important problem. More intensive pain treatm ent strategies addressing the needs of seriously ill hospitalized adul ts must be evaluated. (C) 1998 International Association for the Study of Pain. Published by Elsevier Science B.V.