• Shih-Chieh Yang, Hui-Mei Huang, Te-Feng Yeh, Ching-Hui Shen, Chieh-Liang Wu, Yun-Jui Hsieh, Chih-Cheng Wu, and Chih-Jen Hung.
• Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan.
• Pain Physician. 2023 Jan 1; 26 (1): 616861-68.

BackgroundPain assessments are an important aspect of health care quality because the high prevalence of pain in inpatients may contribute to complications. Several studies revealed a gap in the pain intensity evaluated by nurses (PEN) and patients (PEP). The aim of the present study was to analyze the correlation and agreement between pain assessments conducted by nurses and patients, and to determine patients at high risk of misestimated pain.ObjectivesTo compare the difference of pain intensity between the questionnaires conducted by additional assessors and electronic records by nursing staff.Study DesignA retrospective study.SettingA medical center in Taichung, Taiwan.MethodsWe approached 1,034 patients admitted from January 1, 2018 to December 31, 2018 in our hospital. We compared the assessments of pain intensity using questionnaires conducted by additional assessors with those entered into electronic records by nursing staff. Continuous data were reported as the mean (± standard deviation). The analysis of agreement and correlation were performed by kappa statistics or weighted kappa statistics, and correlation (Spearman rank correlation method).ResultsAmong the 1,034 patients, 307 patients were excluded. Thus, the final analysis included 686 patients. Patients' median pain intensity was 5 in PEP and 1 in PEN. The patients' pain intensity was underestimated (PEN < PEP) in 539 patients (78.6%), matched (PEN = PEP) in 126 patients (18.3%), and overestimated (PEN > PEP) in 21 patients (3.1%). The surgical interventions (chi squared = 7.996, and P = 0.018) and pain in the past 24 hours (chi squared = 17.776, and P < 0.001) led to a significant difference.LimitationsThe limitation of the study was the single-center and retrospective design.ConclusionsThe gap in pain assessments between inpatients and nurses is an important issue in daily practice. The underestimations of pain were more common than overestimations (78.6% vs 3.1%). Surgical interventions and persistent pain lasting over 24 hours were high risk factors for underestimation, but patients' gender, receiving anesthesia, type of anesthesia, and patient-controlled analgesia did not contribute significantly to differences in pain estimation.

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