A new approach to chronic pain in the ED

Rheumatoid Arthritis: A New Challenge in Coming Era

“…Kidney abnormalities have been reported in people taking other NSAIDs as well, which resolve when the drugs are withdrawn. Diabetics taking oral hypoglycemics may need to adjust the dosage to avoid harmful interactions between the drugs [28].…”

Recent advances in the neurophysiology of chronic pain

“…Another aberrant behaviour is termed ‘pseudoaddiction’. This term is used to describe behaviour very similar to that of the drug‐seeker, but which disappears with appropriate management of the pain — narcotic or otherwise 35,36 …”

The valid informed consent-treatment contract in chronic non-cancer pain: Its role in reducing barriers to effective pain management

“…A one-year study of patients with pain presenting to an emergency department showed that 4% to 5% of all patients seen with chronic pain as their major complaint accounted for approximately one-third of the total emergency department visits for this complaint. 16 Unfortunately, this select population of patients produced negative perceptions by physicians and nurses toward the 90%-95% of patients with similar pain problems. Recommendations from this study included better identification of patients with drug dependency linked with referral to appropriate specialists for detoxification and psychiatric therapy.…”

“…Recommendations from this study included better identification of patients with drug dependency linked with referral to appropriate specialists for detoxification and psychiatric therapy. 16 When this approach was implemented, there was overall improvement in medical staff perception of patients with pain in general and improved diagnosing of comorbid psychiatric problems. 16 Following diagnosis of comorbid psychiatric disease, the patient can legitimately be referred to a psychiatrist and pain management specialist as part of a two-armed treatment plan.…”

“…16 When this approach was implemented, there was overall improvement in medical staff perception of patients with pain in general and improved diagnosing of comorbid psychiatric problems. 16 Following diagnosis of comorbid psychiatric disease, the patient can legitimately be referred to a psychiatrist and pain management specialist as part of a two-armed treatment plan. Excellent documentation and ongoing communication between the attending physician, psychiatrist, and pain management specialist further facilitates appropriate treatment and is essential for the protection of the patient and the care-givers.…”