Examination of the clinical factors associated with attendance at emergency departments for chronic pain management and the cost of treatment relative to that of other significant medical conditions

Higgins, Cassie; Smith, Blair H.

doi:10.1097/j.pain.0000000000002098

Cited by 6 publications

(8 citation statements)

References 78 publications

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“…25,26 Establishing relationships with pain specialists also improved access to care that would otherwise be delayed, resulting in worsening pain. 8,10 Our NM subjects saw pain providers more frequently than non-NM subjects. As our center is the only comprehensive pain center in a 2-h radius, the NM subjects seen in the ED were part of this multidisciplinary pain practice.…”

Section: Discussionmentioning

confidence: 83%

Does Neuromodulation Reduce Chronic Pain Patient Emergency Department Utilization?

et al. 2021

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BACKGROUND:Chronic pain (CP) affects roughly 100 million adults in the United States. These subjects present disproportionately to the emergency department (ED). Neuromodulation (NM) has been shown to reduce ED visits longitudinally in subjects.OBJECTIVE:To compare ED utilization rates between subjects with CP with and without NM.METHODS:Subjects with failed back surgery syndrome, complex regional pain syndrome, or neuropathic pain diagnosis who visited the hospital between January 1, 2019, and December 31, 2019, were included. Subjects were divided into a NM-treated cohort and a non-NM cohort. Demographic information, medications, and pain provider visits were obtained. Pain-related ED visits between 2017 and 2019 were compared.RESULTS:A total of 2516 subjects were identified; 291 (11.6%) previously underwent NM. The non-NM cohort had significantly higher rate of pain-related ED visits compared with the NM cohort (15.1% vs 10.0%, P = .018). Younger age (odds ratio [OR] = 0.888 [0.843-0.935]), shorter distance to the hospital (OR = 0.807 [0.767-0.849]), lower household income (OR = 0.865 [0.831-0.901]), opioid use (OR = 1.375 [1.291-1.465]), nonopioid use (OR = 1.079 [1.033-1.128]), and non-NM therapy (OR = 1.751 [1.283-2.390]) were significant predictors of ED visits. Opioid use was the only significant predictor (OR = 6.124 [1.417-26.473]) associated with ED visits in the NM cohort.CONCLUSION:Subjects who underwent NM had fewer visits to the ED when compared with similar subjects who received conventional treatment. Opioid use prompted increased ED utilization in both cohorts. We posit that NM leads to improvement in pain outcomes, integration with multidisciplinary pain specialists, and reduction in severity and frequency of acute pain exacerbations, thereby limiting health care resource utilization.

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Section: Discussionmentioning

confidence: 83%

Does Neuromodulation Reduce Chronic Pain Patient Emergency Department Utilization?

et al. 2021

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“…The cost of chronic pain to society is up to $USD 635 billion due to patients' excessive utilization of healthcare resources (81). In general, chronic pain patients were found to visit the emergency department more frequently than patients without pain (82)(83)(84). More so, the treatment of chronic pain is complex and often results in patients being passed from practice to practice, accumulating bills with little to no relief.…”

Section: Cost-effectiveness Of Scsmentioning

confidence: 99%

Spinal Cord Stimulation as Treatment for Cancer and Chemotherapy-Induced Pain

et al. 2021

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Neuropathic pain is a rampant disease exacting a significant toll on patients, providers, and health care systems around the globe. Neuromodulation has been successfully employed to treat many indications including failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), phantom limb pain (PLP), radiculopathies, and intractable pelvic pain, among many others. Recent studies have also demonstrated efficacy for cancer-related pain and chemotherapy induced neuropathy with these techniques. Spinal cord stimulation (SCS) is the most commonly employed technique and involves implantation of percutaneous or paddle leads targeting the dorsal columns of the spinal cord with the goal of disrupting the pain signals traveling to the brain. Tonic, high frequency, and burst waveforms have all been shown to reduce pain and disability in chronic pain patients. Closed-loop SCS systems that automatically adjust stimulation parameters based on feedback (such as evoked compound action potentials) are becoming increasingly used to help ease the burden placed on patients to adjust their programming to their pain and position. Additionally, dorsal root ganglion stimulation (DRGS) is a newer technique that allows for dermatomal coverage especially in patients with pain in up to two dermatomes. Regardless of the technique chosen, neuromodulation has been shown to be cost-effective and efficacious and should be given full consideration in patients with chronic pain conditions.

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“…Emergency room (ER) visits can be a surrogate marker of HCRU and it has been found that 42% of visits are due to pain ( 51 , 52 ). Further, chronic pain patients with more disability use the ER more than those who have greater function ( 51 , 53 , 54 ). They may visit as often as twice to three times a month due to uncontrolled pain and/or lack of an established care team ( 52 ).…”

Section: A Proposed Model: Multidisciplinary Firmsmentioning

confidence: 99%

Multidisciplinary Firms and the Treatment of Chronic Pain: A Case Study of Low Back Pain

Pilitsis

Khazen²,

Wenzel

2021

Front. Pain Res.

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Sixteen million people suffer with chronic low back pain and related healthcare expenditures can be as high as $USD 635 billion. Current pain treatments help a significant number of acute pain patients, allowing them to obtain various treatments and then “exit the market for pain services” quickly. However, chronic patients remain in pain and need multiple, varying treatments over time. Often, a single pain provider does not oversee their care. Here, we analyze the current pain market and suggest ways to establish a new treatment paradigm. We posit that more cost effective treatment and better pain relief can be achieved with multi-disciplinary care with a provider team overseeing care.

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Examination of the clinical factors associated with attendance at emergency departments for chronic pain management and the cost of treatment relative to that of other significant medical conditions

Abstract: Examination of the clinical factors associated with attendance at emergency departments for chronic pain management and the cost of treatment relative to that of other significant medical conditions.

Cited by 6 publications

References 78 publications

Does Neuromodulation Reduce Chronic Pain Patient Emergency Department Utilization?

Does Neuromodulation Reduce Chronic Pain Patient Emergency Department Utilization?

Spinal Cord Stimulation as Treatment for Cancer and Chemotherapy-Induced Pain

Multidisciplinary Firms and the Treatment of Chronic Pain: A Case Study of Low Back Pain

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