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Pain treatment practices and their impact on patient satisfaction in an Ethiopian Emergency Department: a prospective
Demmelash Gezahegn Nigatu1, Mikiyas G Teferi2, Getaw W Hassen1
1Department of Emergency Medicine and Critical Care, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Introduction:
Undertreatment of pain remains a pervasive challenge in emergency departments (EDs) worldwide, reflecting gaps between patient-reported pain and analgesic prescribing and administration practices. This study evaluates pain treatment practices and examines their effect on patient satisfaction at the Tikur Anbessa Specialized Hospital ED in Ethiopia.
Methods:
A single-center, prospective observational study assessed pain severity using the Numeric Rating Scale (NRS) at triage and 2-4 h after ED arrival, analgesic prescribing and administration practices, and patient satisfaction using a structured questionnaire among adults presenting with acute or subacute pain.
Results:
A total of 106 patients were enrolled, of whom 84 (79.2%) desired analgesia at presentation. Analgesics were prescribed to 54 patients (51.0%) and administered to 44 (41.5%). Tramadol was the most commonly prescribed analgesic (n = 34, 63.0%). Overall satisfaction with pain management was reported by 73 patients (68.9%). In multivariable logistic regression, independent predictors of satisfaction were daytime presentation (aOR 8.09, 95% CI 1.48-44.20, p = 0.016), repeat NRS pain score (per 1-point increase: aOR 0.69, 95% CI 0.57-0.83, p < 0.001), receipt of analgesics in the ED (aOR 4.12, 95% CI 1.68-10.10, p = 0.002), and subjective improvement in pain (aOR 5.89, 95% CI 2.45-14.15, p < 0.001).
Conclusion:
Pain remains frequently undertreated in this tertiary ED, with a substantial gap between patient-reported need and analgesic delivery. Nevertheless, most patients reported satisfaction with pain management, highlighting the limitations of satisfaction as a sole quality indicator. These findings underscore the need for system-level interventions to strengthen pain assessment, timely analgesic administration, and reassessment in resource-constrained emergency care settings.