Letter to the EditorDoes Pain Lead to Tachycardia? Revisiting the Association Between Self-reported Pain and Heart Rate in a National Sample of Urgent Emergency Department Visits
Section snippets
Patients and Methods
We analyzed data from the 2009 and 2010 National Hospital Ambulatory Medical Care Survey (NHAMCS), an annual nationally representative, multistage probability sample survey of hospital EDs.6 The NHAMCS comprises visit-level data (as opposed to patient-level data) including patient demographic characteristics, vital signs, reasons for visits, diagnoses, and medications. Vital signs included are those recorded as a patient is assessed in triage. Although the survey includes visits to ambulatory
Results
Our sample included 10,617 ED visits, with white patients comprising 81.4% (8639 visits). Among all patients, the adjusted heart rate for a self-reported pain score of 1 was 84.9 beats/min (95% CI, 82.8-86.9 beats/min), increasing slightly to 88.0 beats/min (95% CI, 87.3-88.8 beats/min) when self-reported pain score was 10 (Table).
Overall, heart rate and self-reported pain were correlated among whites, but the association was modest. For example, the adjusted heart rate for pain scores of 1 and
Discussion
Contrary to the classic teaching that tachycardia is a clinical sign of pain, we found only a small positive association between self-reported pain and heart rate in a large sample of white patients treated in ED settings and no association among black patients, which may suggest that the relationship between pain and heart rate differs slightly by race. Although our findings should be interpreted primarily as hypothesis-generating, they raise the possibility that pain and heart rate are not
Acknowledgments
The National Institutes of Health had no involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Dr Jena had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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Grant Support: This work was supported by Early Independence Award grant 1DP5OD017897-01 from the Office of the Director, National Institutes of Health (A.B.J.).