Factors Predicting Pain in Trauma Patients before Hospital Discharge

Main Article Content

Atiphat Promsombut
Suporn Danaidutsadeekul
Orapan Thosingha
Jatuporn Sirikun


Purpose: This research aimed to investigate the predictive power of pain on arrival at emergency department, severity of injury, substance use, and comorbidity on pain in trauma patients before hospital discharge.

Design: Correlational predictive design. 

Methods: The sample consisted of 85 patients who were treated at emergency department and admitted to surgery departments at secondary and tertiary hospitals in Saraburi and Lopburi province. The research intruments used for data collection were demographic data, injury and treatment form, injury severity score, substance use questionaire, comorbidity questionaire, and brief pain inventory. Data analysis was performed by using stepwise regression method.

Main findings: The result revealed that the participants had moderate score on pain intensity before hospital discharge (gif.latex?\bar{X} = 4.53, SD = 1.30), pain interference (gif.latex?\bar{X} = 5.42, SD = 1.52), pain on arrival at emergency department (gif.latex?\bar{X} = 6.82, SD = 1.99), and severity of injury (gif.latex?\bar{X} = 12.46, SD = 4.84). Substance use and comorbidity were found in 55.30% and 18.80% of the participants, respectively. Severity of injury and substance use could significantly predict pain intensity in trauma patients before hospital discharge (gif.latex?\beta = .373, p < .001, and gif.latex?\beta = .304, p < .001, respectively), whereas, pain on arrival at emergency department and comorbidity could not.

Conclusion and recommendations: This finding indicated that severity of injury and substance use could predict pain before hospital discharge. Therefore, nurses should be aware of acute pain and provide proper pain manangement in major trauma patients who have either severe injury or substance use.

Article Details

How to Cite
Promsombut, A., Danaidutsadeekul, S. ., Thosingha, O., & Sirikun, J. . (2020). Factors Predicting Pain in Trauma Patients before Hospital Discharge. Nursing Science Journal of Thailand, 38(2), 59–73. Retrieved from https://he02.tci-thaijo.org/index.php/ns/article/view/239891
Research Papers


Bureau of Non Communicable Diseases, Ministry of Public Health. Annual report 2015. Bangkok: WVO Officer of Printing Mill; 2016. (in Thai).

McCaig LF, Nawar EW. National hospital ambulatory medical care survey: 2004 emergency department summary. Adv Data. 2006;23(372):1-29.

Berben SA, Schoonhoven L, Meijs TH, van Vugt AB, van Grunsven PM. Prevalence and relief of pain in trauma patients in emergency medical services. Clin J Pain. 2011;27(7):587-92. doi: 10.1097/AJP.0b013e3182169036.

Melzack R. From the gate to the neuromatrix. Pain. 1999;Suppl 6:S121-6. doi: 10.1016/S0304-3959(99)00145-1.

Mei W, Seeling M, Franck M, Radtke F, Brantner B, Wernecke KD, et al. Independent risk factors for postoperative pain in need of intervention early after awakening from general anaesthesia. Eur J Pain. 2010;14(2):149.e1-7. doi: 10.1016/j.ejpain.2009.03.009.

Gélinas C, Fillion L, Puntillo KA, Viens C, Fortier M. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care. 2006;15(4):420-7.

Smeltzer SC, Bare BG, Hinkle JL, Cheever KH. Brunner & Suddarth’s textbook of medical-surgical nursing. 12th ed. Philadelphia: Lippincott Williams & Wikins; 2010. 2368 p.

Mondello S, Cantrell A, Italiano D, Fodale V, Mondello P, Ang D. Complications of trauma patients admitted to the ICU in level I academic trauma centers in the United States. BioMed Res Int. 2014;2014:473419. doi: 10.1155/2014/473419.

Goldsmith H, Curtis K, McCloughen A. Analgesic adherence in recently discharged trauma patients: an integrative literature review. Pain Manag Nurs. 2016;17(1):63-79. doi: 10.1016/j.pmn.2015.12.001.

Archer KR, Castillo RC, Wegener ST, Abraham CM, Obremskey WT. Pain and satisfaction in hospitalized trauma patients: the importance of self-efficacy and psychological distress. J Trauma Acute Care Surg. 2012;72(4):1068-77. doi: 10.1097/TA.0b013e3182452df5.

Goldsmith H, Curtis K, McCloughen A. Effective pain management in recently discharged adult trauma patients: identifying patient and system barriers, a prospective exploratory study. J Clin Nurs. 2017;26(23-24):4548-57. doi: 10.1111/jocn.13792.

Goldsmith H, Curtis K, McCloughen A. Incidence, intensity, and impact of pain in recently discharged adult trauma patients: an exploratory study. J Trauma Nurs. 2017;24(2):102-9. doi: 10.1097/JTN.0000000000000273.

Daoust R, Paquet J, Moore L, Emond M, Gossenlin S, Lavinge G, et al. Early factors associated with the development of chronic pain in trauma patients. Pain Res Manag. 2018;2018:7203218. doi: 10.1155/2018/7203218.

Trevino C, Harl F, Deroon-Cassini T, Brasel K, Litwack K. Predictors of chronic pain in traumatically injured hospitalized adult patients. J Trauma Nurs. 2014;21(2):50-6. doi: 10.1097/JTN.0000000000000032.

Starkweather A, Julian T, Ramesh D, Heineman A, Sturgill J, Dorsey SG, et al. Circulating lipids and acute pain sensitization: an exploratory analysis. Nurs Res. 2017;66(6):454-61. doi: 10.1097/NNR.0000000000000248.

Holmes A, Williamson O, Hogg M, Arnold C, Prosser A, Clement A, et al. Predictors of pain severity 3 months after serious injury. Pain Med. 2010;11(7):990-1000. doi: 10.1111/j.1526-4637.2010.00890.x.

Archer KR, Heins SR, Abraham CM, Obremskey WT Wegener ST, Castillo RC. Clinical significance of pain at hospital discharge following traumatic orthopaedic injury: general health, depression, and PTSD outcomes at 1 year. Clin J Pain. 2016;32(3):196-202. doi: 10.1097/AJP.0000000000000246.

Kao SC, Tsai HI, Cheng CW, Lin TW, Chen CC, Lin CS. The association between frequent alcohol drinking and opioid consumption after abdominal surgery: a retrospective analysis. PLoS One. 2017;12(3):e0171275. doi: 10.1371/journal.pone.0171275.

Salottolo K, Peck L, Carrick M, Tanner A 2nd, Madayag R, McGuire E, et al. High on drugs: multi-institutional pilot study examining the effects of substance use on acute pain management. Injury. 2019;50(5):1058-63. doi: 10.1016/j.injury.2019.01.003.

Kirshenbom D, Ben-Zaken Z, Albilya N, Niyibizi E, Bala M. Older age, comorbid Illnesses, and injury severity affect immediate outcome in elderly trauma patients. J Emerg Trauma Shock. 2017;10(3):146-50. doi: 10.4103/JETS.JETS_62_16.

Griffiths J, Putthioi S, Pongsuksri M. The General Practitioner Assessment of Cognition; GP-COG (Thai version): validity and reliability. In: 9th Pan-Pacific Conference on Rehabilitation cum 21st Annual Congress of Gerontology; 2014 Nov 29-30; Hong Kong. Kowloon: The Hong Kong Polytechnic University; [2014]. p.B65. (in Thai).

Baker SP, O'neill B, Haddon W Jr, Long WB. The injury score: a method for describing patient with multiple injury and evaluating emergency care. J Trauma. 1974;14(3):187-96.

Cleeland CS. The brief pain inventory user guide. Houstan, TX: The University of Texas MD Anderson Cancer Center; 2009. 65 p.

Zale EL, Stephen SA, Ditre JW. Interrelation between pain and alcohol: an intregrative review. Clin Psychol Rev. 2014;37:57-71. doi: 10.1016/j.cpr.2015.02.005

Hone AJ, McIntosh JM. Nicotinic acetylcholine receptors in neuropathic and inflammatory pain. FEBS Lett. 2018;592(7):1045-62. doi: 10.1002/1873-3468.12884.

Bán EG, Brassai A, Vizi ES. The role of the endogenous neurotransmitters associated with neuropathic pain and in the opioid crisis: the innate pain-releiving system. Brain Res Bull. 2020;155:129-36. doi: 10.1016/j.brainresbull.2019.12.001.