Evaluating Differences in Patient Perception of Effectiveness of Oral Versus Parenteral Non-Steroidal Anti-Inflammatory Drugs

BACKGROUND: Pain is a very common reason for emergency department (ED) visits. Providing safe, effective analgesia is not only central to providing good health care, but also to overall patient satisfaction. Prior work has shown that although parenteral administration of NSAIDs is more expensive and has greater risk of adverse effects than oral administration, there are no significant differences between the two routes in amount or efficiency of pain relief. However, some clinicians believe that patients presenting with pain to the ED prefer parenteral over oral NSAIDs, due to an assumed patient perception that shots are more effective than pills. Additionally, prior studies in this area have not examined patient ethnicity as a factor in administration preference. OBJECTIVE: To determine the extent to which patient preference for oral versus parenteral methods of NSAID administration can be influenced by education. METHODS: All patients who presented to a county hospital ED with a chief complaint of pain and were subsequently prescribed any type of NSAID were included. After obtaining consent, a survey was given in English or Spanish to obtain demographic data and question the patient on three items: (1) Which NSAID form (pill or shot) is better at taking away pain (2) Which NSAID form is faster at taking away pain (3) Which NSAID form is preferred to take away pain. This preference survey was repeated after educating the patient that the shot and the pill are equally effective but the shot costs more and causes pain. Statistical analysis was performed using standard methods. RESULTS: N=270 patients were surveyed, with mean age 42; 49% female; and 37% African American, 37% Hispanic, and 23% Caucasian. Before education, overall subjects were equally likely to prefer the pill versus the shot but believed the shot to be faster (82%) than the pill (17%). Patient education on NSAIDs significantly influenced patient beliefs on all three items: 73% found the pill to be as effective as the shot, 55% found the pill to be as fast as the shot, and 75% preferred the pill (p<0.001 in all three cases). There were no statistically significant differences in any of these beliefs across patient ethnicity, education, or narcotic preference. CONCLUSION: Despite clinician assumptions, most patients have favorable attitudes toward NSAID pill versus shot effectiveness and overall preference, and can be easily influenced by briefly educating these patients in the ED. This suggests brief patient education is effective to reduce cost of treating minor pain in the ED. Future work should compare effectiveness of various education methods.