{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:10:35Z","timestamp":1787022635733,"version":"build-2736575974"},"reference-count":21,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2019,9,19]],"date-time":"2019-09-19T00:00:00Z","timestamp":1568851200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,12,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_sjpain-2019-0077_s_001\">\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Previous studies have described the phenomenon of oligo-analgesia in Emergency Department patients with traumatic injuries, despite the high prevalence of pain among these patients. Besides aspects related to health care staff, patient related factors might also play a role in suboptimal pain treatment, however evidence is scarce. Therefore, the objective of the current study was to evaluate patient related factors in adult patients refusing offered analgesics during an Emergency Department presentation with extremity injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_sjpain-2019-0077_s_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a case control study in the Emergency Department of a level 1 Trauma Centre. Cases were defined as adult patients with an extremity injury who declined analgesia, when offered. They were matched to controls from the same population, who accepted analgesics, in a 1:2 ratio using gender as matching variable. Primary outcome was difference in NRS pain score. Secondary outcomes were the relationship between categorical severity of pain scores and refusal of analgesics, exploration of independent predictors of analgesia refusal utilizing multivariate logistic regression and the evaluation of eight beliefs among patients who refuse analgesics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_sjpain-2019-0077_s_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between August 1st and 31st 2016, a total of 253 patients were eligible for inclusion of whom 55 declined analgesic treatment. They were included as cases and matched to 110 controls. Difference in median NRS pain score was significant between the groups: 5.0 (IQR 3.0\u20138.0) vs. 8.0 (IQR 6.0\u20139.0), respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Nearly 20% of patients with severe pain declined analgesics, compared to 41% with moderate and 69% with mild pain (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). The NRS pain score was the only independent predictor of refusal of analgesic treatment with a mean Odds Ratio of 0.67 (95%-CI 0.54\u20130.83). Most common patients\u2019 beliefs were that pain medication should be used in extreme pain only, fear of decreasing the doctor\u2019s ability to judge the injury and fear of addiction to analgesics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_sjpain-2019-0077_s_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pain severity is the single independent predictor of refusal of analgesia, however the following patient beliefs are important as well: pain medication should be used in extreme pain only; fear of decreasing the doctor\u2019s ability to judge the injury and the fear of becoming addicted to pain medication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_sjpain-2019-0077_s_005\">\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>In case patients refuse offered analgesics, the health care provider should actively address patient beliefs that might exist and lead to suboptimal pain treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/sjpain-2019-0077","type":"journal-article","created":{"date-parts":[[2019,9,19]],"date-time":"2019-09-19T05:03:24Z","timestamp":1568869404000},"page":"87-94","source":"Crossref","is-referenced-by-count":3,"title":["The relationship between patient factors and the refusal of analgesics in adult Emergency Department patients with extremity injuries, a case-control study"],"prefix":"10.1515","volume":"20","author":[{"given":"Milan L.","family":"Ridderikhof","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Amsterdam UMC \u2013 Location AMC , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donica V.","family":"Lodder","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Amsterdam UMC \u2013 Location AMC , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Van Dieren","sequence":"additional","affiliation":[{"name":"Clinical Research Unit, Amsterdam UMC \u2013 Location AMC , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Lirk","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology , Brigham and Women\u2019s Hospital , Boston , MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helma","family":"Goddijn","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Amsterdam UMC \u2013 Location AMC , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Carel","family":"Goslings","sequence":"additional","affiliation":[{"name":"Trauma Unit, Department of Surgery , Onze Lieve Vrouwe Gasthuis , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus W.","family":"Hollmann","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology , Amsterdam UMC \u2013 Location AMC , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2019,9,19]]},"reference":[{"key":"2025120910031658093_j_sjpain-2019-0077_ref_001","doi-asserted-by":"crossref","unstructured":"Berben SA, Meijs TH, van Dongen RT, van Vugt AB, Vloet LC, Mintjes-de Groot JJ, van Achterberg T. Pain prevalence and pain relief in trauma patients in the Accident & Emergency department. 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