Pain treatment practices and their impact on patient satisfaction in an Ethiopian Emergency Department: a prospective observational study

Undertreatment of pain remains a pervasive challenge in emergency departments (EDs) worldwide, reflecting gaps between patient-reported pain and analgesic prescribing and administration practices. This study evaluates pain treatment practices and examines their effect on patient satisfaction at the Tikur Anbessa Specialized Hospital ED in Ethiopia. A single-center, prospective observational study assessed pain severity using the Numeric Rating Scale (NRS) at triage and 2–4 h after ED arrival, analgesic prescribing and administration practices, and patient satisfaction using a structured questionnaire among adults presenting with acute or subacute pain. A total of 106 patients were enrolled, of whom 84 (79.2%) desired analgesia at presentation. Analgesics were prescribed to 54 patients (51.0%) and administered to 44 (41.5%). Tramadol was the most commonly prescribed analgesic ( n = 34, 63.0%). Overall satisfaction with pain management was reported by 73 patients (68.9%). In multivariable logistic regression, independent predictors of satisfaction were daytime presentation (aOR 8.09, 95% CI 1.48–44.20, p = 0.016), repeat NRS pain score (per 1-point increase: aOR 0.69, 95% CI 0.57–0.83, p < 0.001), receipt of analgesics in the ED (aOR 4.12, 95% CI 1.68–10.10, p = 0.002), and subjective improvement in pain (aOR 5.89, 95% CI 2.45–14.15, p < 0.001). Pain remains frequently undertreated in this tertiary ED, with a substantial gap between patient-reported need and analgesic delivery. Nevertheless, most patients reported satisfaction with pain management, highlighting the limitations of satisfaction as a sole quality indicator. These findings underscore the need for system-level interventions to strengthen pain assessment, timely analgesic administration, and reassessment in resource-constrained emergency care settings.