The role of the emergency department in the acute management of chronic or recurrent pain

McLeod, Diane; Nelson, Kathy

doi:10.1016/j.aenj.2012.12.001

Cited by 31 publications

(29 citation statements)

References 35 publications

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“…Also of concern, more than half (56.4%) used the emergency room (ER) for pain treatment at least occasionally. In addition to being costly (Machlin, 2006), ERs are not the ideal settings for the management of chronic pain as physicians in these settings often do not have the time and resources necessary to systematically screen for and monitor patients for potential misuse, abuse, dependence, and diversion (McLeod and Nelson, 2013). Numerous factors, in addition to opioid seeking/doctor shopping, could account for ER utilization rates among this sample and it is important for future research to explore a range of factors found to contribute to overall ER utilization, including lack of access to other providers (Gindi et al, 2012) and legitimate under-treatment of chronic pain (IOM, 2011).…”

Section: Discussionmentioning

confidence: 99%

Pain management perceptions among prescription opioid dependent individuals

McCauley

Mercer

Barth

et al. 2014

Drug and Alcohol Dependence

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Background Nearly two-thirds of prescription opioid dependent individuals report chronic pain conditions as both an initial and current motivation for prescription opioid use. However, to date, limited information exists regarding perceptions of the adequacy of pain management and pain management behaviors among prescription opioid dependent individuals with a history of treatment for chronic pain. Methods The current study examined perceptions of the medical management of chronic pain among community-recruited individuals (N=39) who met DSM-IV-TR criteria for current prescription opioid dependence and reported a history of treatment for chronic pain. Prescription opioid dependence, symptoms of depression, and pain management perceptions were assessed using the Structured Clinical Interview for DSM Disorders, Beck Depression Inventory, and the Pain Management Questionnaire, respectively. Results Reports of insufficient pain management were common (46.2%), as was utilization of emergency room services for pain management (56.4%). Nearly half reported a physician as their initial source (46.2%) and pain management as their primary initial reason for prescription opioid use (53.8%), whereas 35.9% reported pain relief as their primary reason for current prescription opioid use. Symptoms of depression were common (51.3%), as was comorbid abuse of other substances and history of treatment for substance abuse. Conclusions Results highlight the complicated clinical presentation and prevalent perception of the under-treatment of pain among this population. Findings underscore the importance of interdisciplinary approaches to managing the complex presentation of chronic pain patients with comorbid prescription opioid dependence. Implications for future research are discussed.

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Section: Discussionmentioning

confidence: 99%

Pain management perceptions among prescription opioid dependent individuals

McCauley

Mercer

Barth

et al. 2014

Drug and Alcohol Dependence

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“…To further complicate things, the subset of patients with substance use disorders that present to the ED in pain often will do so in states of intoxication or withdrawal. As a result, these patients can engender mistrust among providers and make the pain evaluation process even more difficult as these patients are frequently somnolent, uncooperative, irritable, or agitated [1].…”

Section: Evaluation Of the Chronic Pain Patientmentioning

confidence: 99%

“…This may establish parameters for acute management, help establish pain patterns to help with diagnosis or patient care, and steer ongoing treatment after the ED visit. Besides an exacerbation of chronic pain, patients come to the ED due to inadequate coping strategies as well as desperation associated with stress and anxiety [1]. Emergency providers can help guide these patient needs to the appropriate outpatient setting.…”

Section: Evaluation Of the Chronic Pain Patientmentioning

confidence: 99%

“…For patients and providers alike, the need to have a diagnosis to be treated was also identified as a barrier. Finally, aggressive or antisocial behaviors from substance users require significant attention and resources by ED staff with time constraints and without the benefit of an extended timeline of care and can cause significant dissatisfaction [1].…”

Section: Barriers To Effective Managementmentioning

confidence: 99%

“…Pain is a common presenting complaint in the emergency department (ED) [1]. In fact, it is estimated 40 % or more of patients' chief complaints are pain related, of which a significant proportion have a moderate to severe intensity pain rating [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

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The Chronic Pain Patient in the Emergency Department

Bhatt

2016

Curr Emerg Hosp Med Rep

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Pain presentations are very common in the emergency department (ED), of which an estimated 12-16 % of total ED visits are from patients with chronic pain-related complaints (McLeod and Nelson in Australas Emerg Nurs J 16:30-36, 2013). The ED physician frequently has few tools to manage chronic pain patients, and is often times limited to pharmacological means of alleviating the patient's suffering. For chronic pain patients, the ED only represents a fraction of their total longitudinal care. This article presents the scope of chronic pain, evaluation issues of the chronic pain patient, barriers to effective management, targeted pharmacotherapy suggestions, patient assessment strategies, prescribing guidelines, and other outpatient modalities used for treatment of chronic pain. The goal of this article is to improve the reader's understanding of the issues surrounding the chronic pain patient and improve the care of these patients.

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An interdisciplinary program for familiar faces with chronic pain visiting the emergency department—randomized controlled trial

et al. 2022

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Objectives To evaluate the effect of a collaborative interdisciplinary pain assessment program on pain and health‐related quality of life among individuals with chronic pain who frequently visit the emergency department (ED). Methods Individuals with chronic pain who frequented the ED (ie, ≥8 visits within the previous 12 months) were randomly assigned to a collaborative chronic pain management program or treatment as usual. Primary outcomes were change in physical function and visits to the ED from baseline to 12 months using validated measures. Secondary measures included physical and emotional functioning, insomnia, health‐related quality of life, risk of aberrant opioid use, and health care use. Mixed model analyses of variances were used to evaluate intervention effectiveness among the whole sample (ie, using intention to treat principles) and individuals who completed more than 50% of follow‐up assessments. Results One hundred participants were assessed for eligibility and 46 patients were enrolled with 24 being randomized to intervention and 22 to treatment as usual (TAU). Eleven of the 24 patients randomized to the intervention were lost to follow‐up and 3 withdrew participation. Two of the 22 patients randomized to TAU were lost to follow‐up, and 7 withdrew. Although patients assigned to the intervention improved more rapidly on measures of pain and health related quality of life, both groups had similar improvements overall between baseline to 12 months. Average pain intensity reduction (numeric rating scale [SE]) was 4.63 (0.40) in the intervention and 4.82 (0.53) in the treatment as usual at the 12‐month follow‐up. A significant group × time interaction was present for risk of aberrant opioid use, with individuals in the intervention group reporting greater improvement in risk of aberrant opioid use by 12‐month follow‐up. Conclusion Participation in an interdisciplinary program may accelerate improvements in pain‐ and health‐related quality of life and reduce risk of aberrant opioid use to manage pain and related distress. Further research is needed to better understand and address barriers to engagement in chronic pain care.

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The role of the emergency department in the acute management of chronic or recurrent pain

Cited by 31 publications

References 35 publications

Pain management perceptions among prescription opioid dependent individuals

Pain management perceptions among prescription opioid dependent individuals

The Chronic Pain Patient in the Emergency Department

An interdisciplinary program for familiar faces with chronic pain visiting the emergency department—randomized controlled trial

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