(324) Characterizing Expectations for Functional Outcomes in Emergency Department Patients with Musculoskeletal Pain

Abstract

Over 13% of Emergency Department (ED) visits are for musculoskeletal pain, but little is known about ED patients’ expectations for pain management and pain-related functional outcomes. This cross-sectional study surveyed adults seeking care at an academic ED with a primary complaint of neck, back or extremity pain. Survey data included the previously validated Patient Centered Outcomes Questionnaire to rate pain interference with activities on a scale of 0 (none) to 100 (worst imaginable) across usual, desired, successful, and expected outcome levels, as well as patient-reported use of various pharmacological and non-pharmacological modalities for pain relief. Responses were analyzed from 106 patients, with mean age 42.4 years (SD 15.6); 52% female; 63% African American and 27% Caucasian. For primary location of pain, 46% identified back, 32% leg, 13% arm, and 11% neck. Median duration of pain was 3 days (IQR 1-7), and 36% reported previous episodes of this pain. Reported median usual pain interference with activities in the past week was 66 (IQR 40-94). Patients desired a median 100% reduction (IQR 89-100%) in interference, but considered 77% reduction successful (IQR 49-100%), and only expected a 52% reduction (IQR 9-91%) after treatment. Most patients were willing to take opioid (73%) and non-opioid (79%) pain medications, despite only 32% having taken an opioid and 55% having taken a non-opioid for pain. Most were also willing to engage in non-pharmacological treatments including direct/passive modalities such as heat, cold packs, acupuncture, and massage (84%); indirect/psychosocial modalities such as music, prayer and meditation (80%); and physical/active modalities such as yoga, exercise, and physical therapy (66%). However, current use of non-pharmacological modalities only ranged from 36-50%. This foundational data highlights an opportunity to incorporate patient perspectives in setting treatment goals and expanding treatment options for integrated, multi-modal pain management in the ED.