The Effective Health Care Program of the Agency for Healthcare Research and Quality, or AHRQ, has released guides for clinicians(www.effectivehealthcare.ahrq.gov) and patients and their caregivers(www.effectivehealthcare.ahrq.gov) regarding pain management after a hip fracture.
The guides are based on a comparative effectiveness review(www.effectivehealthcare.ahrq.gov) conducted by researchers at AHRQ's University of Alberta Evidence-based Practice Center in Edmonton.
Overall, said the researchers, who analyzed 83 studies, a lack of quality evidence precluded firm conclusions for any single approach to optimal overall pain management. However, the data available showed that most interventions result in improvements in short-term, patient-reported pain scores, although few differences of long-term clinical importance were seen when comparisons between interventions were available.
The researchers emphasized that well-designed, long-term trials are needed to determine the relative effectiveness of pain interventions for hip fracture patients.
"Until then, pain management in this population will rely heavily on availability of the interventions, staff skills, and training and preexisting patient comorbidities," they noted.
The clinician guide covers the following treatment options:
- systemic analgesics,
- spinal and epidural anesthesia,
- nerve blocks,
- skin traction,
- transcutaneous electrical nerve stimulation,
- acupressure and relaxation techniques,
- rehabilitation, and
- multimodal approaches.
According to the guide, moderate evidence shows that nerve blockers reduce the intensity of acute pain and reduce the incidence of delirium. However, most studies dealing with these medications did not report on how nerve blockades may affect ambulation or mobility.
Meanwhile, available evidence indicates that rehabilitation, relaxation therapy and transcutaneous electrical nerve stimulation may be associated with "potentially clinically meaningful reductions in pain," but the researchers indicated that additional study is needed.
Preoperative traction and spinal anesthesia -- with or without additional agents -- did not
consistently reduce pain in any demonstrable way compared with standard care, said the review.
The guide for patients covers the following topics:
- the importance of pain management during treatment for and recovery from a broken hip,
- a description of treatment options, and
- evidence about benefits and risks of these interventions.
To order free print copies of either guide or the full systematic review, call the AHRQ Publications Clearinghouse at (800) 358-9295.