Objective: To determine how the origin of acute pain influences its semiological characteristics, and to evaluate the efficacy and safety of two Level 2 analgesic combinations in general practice.
Research design and methods: This prospective, observational, multicenter study enrolled patients who consulted general practitioners across France for intense pain that lasted ≥7 days and for which the physician prescribed paracetamol-codeine or paracetamol-tramadol. Completed physician (Day 0) and patient (Days 0-3 and Days 4-7) questionnaires provided data on the origin, characteristics, impact, and treatment of the pain, during the 7 days after the initial consultation.
Main outcome measures: Pain intensity (0-10 unidimensional numerical scale), type (SF-MPQ) and impact on quality of life (QoL; SF-12).
Results: Overall, 1003 patient questionnaires were completed for Days 0-3 and 941 for Days 4-7. The origin of pain was most commonly disease or trauma. Mean baseline pain intensity was 7 (SD 1.3; 0-10 numerical rating scale), and was similar regardless of the origin. The time-course of pain differed according to its origin: more than two-thirds of patients with trauma/work accident related pain described it as being constant, whereas 43% of those with disease-related pain described it as recurrent/intermittent. The origin of pain also influenced its QoL impact: trauma/work accident related pain led to functional and/or professional temporary incapacity in 77% and 83% of patients (vs 63% for disease-related pain), while disease-related pain led to a change in mood and/or feeling of anxiety in 79% of patients (vs 47% [trauma] and 58% [work accident related]). Both paracetamol-codeine and paracetamol-tramadol reduced pain intensity by approximately 75% and were well tolerated. Key limitations relate to the observational study design, countered by advantages gained from the 'real life' evaluation of acute pain and its treatment in a general medical practice setting.
Conclusions: Acute pain should not be understood as a single entity but as multiple entities with specific characteristics related to its underlying origin. Furthermore, our data suggest that, as already demonstrated in clinical trials, Level 2 analgesia provides effective relief of acute pain in 'real life' conditions.