Pain is commonly reported by hospitalized patients and may be managed with opioids, which are associated with benefits and harms. Clinicians’ perceptions of the benefit to harm ratio may differ across countries, which may lead to variability in prescribing practices. We sought to determine whether there was an association between willingness to prescribe opioids and patients’ perception of pain control.
We conducted a cross-sectional survey of adult patients admitted to hospital who: (1) reported pain, (2) had been hospitalized for 24 to 36 hours, (3) spoke the primary language of their country, and (4) provided informed consent. Patients were not eligible for our study if they were: (1) in an intensive care unit care, (2) incarcerated, (3) pregnant, (4) post-operative, (5) diagnosed with cancer, or (6) hospice or palliative care patients. Eligible patients completed the American Pain Society Patient Outcome Questionnaire (APS-POQ); we conducted chart reviews to determine if they had been prescribed opioids. Primary outcome was the proportion of patients who received opioids and secondary outcomes were patient pain levels and satisfaction with pain control. Student’s t-test or a Wilcoxon Rank Sum test was used to compare continuous variables depending on results of normality tests. Chi-square tests were used to compare categorical variables.
From October 8, 2013 to August 31, 2015, we surveyed 981 patients (Table 1). Seventy-five percent (N=377) of patients at U.S. hospitals and 49% (N=235) of patients hospitalized in 7 other countries were prescribed opioids. At discharge, 53% of U.S. patients and 23% non-U.S. patients were prescribed an opioid. After controlling for age, gender, race/ethnicity, Charlson Comorbidity Index score, patient-reported pain level and patient-reported prior narcotic use, patients hospitalized in the U.S. were 4.7 times more likely to receive a prescription for opioids versus non-U.S. patients (p-value <0.0001). Moreover, opioid doses were much higher among U.S. vs. non-U.S. patients (median of 48MME/day (IQR, 23 to 100) vs. 22MME/day (IQR, 15 to 48); however, there was no significant difference in pain satisfaction scores between patients hospitalized in the U.S. or elsewhere (p=0.27) (Table 2).
Patients who present with pain at hospitalization are much more likely to receive opioids, higher doses of opioids, and be discharged with a prescription for opioids in the U.S. versus other countries; however, there was no significant difference in pain satisfaction scores.