Abstract
BackgroundIn the face of the opiate addiction epidemic, there is a paucity of research that evaluates limitations for our current pain rating methodologies for patient populations at risk for drug seeking behavior. ObjectiveWe hypothesized that VAS scores would be higher and show less serial improvement for patients with a history of frequent ED use. MethodsThis was a prospective, observational cohort study of a convenience sample of adult ED patients with chief complaint of pain. Initial VAS scores were recorded. Pain scores were subsequently updated 30–45 min after pain medication administration. ED frequenter defined as having >4 ED visits over a 1-year time period. Categorical data analyzed by chi-square; continuous data analyzed by t-tests. A multiple linear regression performed to control for confounding. Results125 patients were enrolled; 51% ED frequenters. ED frequenters were similar to non-ED frequenters with respect to gender, mean age, Hispanic race, educational level, chief complaint type, and initial pain medication narcotic. ED frequenters more likely to have higher initial VAS score (9.17+/-1.25 vs. 8.51+/-1.68; p = 0.01) and higher second VAS scores (7.48+/-2.56 vs. 5.00+/-3.28; p <0.001) and significantly lower mean change in first to second VAS scores (1.69+/-2.17 vs. 3.51+/-3.25; p <0.001). Within our multiple linear regression model, only ED frequenter group (p < 0.001) and private insurance status (0.04) were associated with differences in mean reduction in pain scores. ConclusionWe found that ED frequenters had significantly less improvement between first and second VAS measurements.
Highlights
Pain is one of the most commonly encountered chief complaints in the emergency department [1]
The most common chief complaint was abdominal pain, which accounted for 81% of emergency department (ED) visits in our study
The two groups were similar with respect to the distribution of chief complaint types (p 1⁄4 0.68), and there was no statistical difference in the frequency for which they received an initial dose of narcotics (71% vs. 79%; p 1⁄4 0.26)
Summary
In 2015, the Center for Disease Control identified abdominal pain as the leading cause of emergency department (ED) presentation (8.8%), followed by chest pain (5.3%) and headache (2.8%), with painful conditions in aggregate comprising nearly 20 percent of all ED visits [2]. With this backdrop, regulatory agencies including the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and Centers for Medicare and Medicaid (CMS) have increasingly emphasized pain management in their assessment of health facility and provider competence. Conclusion: We found that ED frequenters had significantly less improvement between first and second VAS measurements
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