Comprehensive Discharge Instructions for Patients with Persistent Pain Despite Normal Labs
For patients with persistent pain despite normal laboratory results, discharge instructions should include follow-up with both orthopedics and psychiatry, along with a multimodal pain management approach that addresses both physical and psychological aspects of trauma-related pain.
Pain Management Approach
Non-Pharmacological Management
- Apply ice to the painful area for 15-20 minutes several times daily 1
- Elevation of the affected limb when possible and limited movement for 24-48 hours to reduce pain and discomfort 1
- Provide educational materials about pain management strategies, including sleep hygiene guidelines and encouragement to stay physically active as tolerated 2
Pharmacological Management
- Acetaminophen 650 mg every 6 hours (maximum 3000-4000 mg daily) as the first-line analgesic option 1
- Consider NSAIDs such as ibuprofen if no contraindications exist 1
- Avoid prescribing opioids at discharge if possible; if required, provide clear tapering instructions 3
- If opioids are necessary, provide:
Follow-Up Appointments
Orthopedic Follow-Up
- Schedule within 2 weeks for higher-risk patients or those with significant pain 2
- Provide written instructions with appointment date, time, and location
- Explain the importance of this follow-up for monitoring pain progression and functional recovery
Psychiatric/Psychological Follow-Up
- Schedule within 14 days of discharge 4
- Explain that psychological support is a standard part of trauma care, not an indication that pain is "in their head"
- Emphasize that addressing psychological aspects of trauma improves overall outcomes and pain management 4
Patient Education
Pain Understanding
- Explain that persistent pain after trauma is common and may have multiple contributing factors
- Clarify that normal laboratory results do not invalidate the patient's pain experience
- Provide information about how psychological distress can amplify pain perception 5
Warning Signs
- Instruct patients to seek immediate medical attention if:
- Pain significantly worsens or changes in character
- New neurological symptoms develop (numbness, tingling, weakness)
- Signs of infection appear (increasing redness, warmth, fever) 1
- Pain persists despite following recommended pain management strategies
Self-Management Strategies
Self-Efficacy Building
- Provide specific techniques for pain coping and self-management 5
- Encourage gradual return to normal activities as tolerated
- Suggest keeping a pain diary to identify patterns and triggers
Mental Health Support
- Provide resources for managing trauma-related psychological distress 4
- Teach basic relaxation and stress management techniques
- Emphasize that addressing psychological aspects of trauma is essential for optimal recovery 5
Common Pitfalls and How to Avoid Them
Inadequate pain management: Studies show that approximately 70% of emergency department patients receive no analgesia or receive it with remarkable delay 6. Ensure appropriate multimodal pain management is initiated before discharge.
Opioid management issues: Patients are often discharged with prescribed opioids without information about their addictive properties or tapering plans 3. Always provide clear written instructions about safe opioid use and tapering.
Neglecting psychological impact: The psychological impact of trauma is frequently overlooked despite its significant influence on pain perception and recovery 4. Always include mental health assessment and support in discharge planning.
Poor communication: Inadequate explanation of pain mechanisms and management strategies leads to patient dissatisfaction 5. Take time to explain the pain management plan thoroughly and address patient concerns.
By implementing these comprehensive discharge instructions, healthcare providers can better address both the physical and psychological aspects of persistent pain following trauma, potentially improving patient outcomes and satisfaction.