Chronic Pain in the Emergency Department: A Pilot Mixed-Methods Cross-Sectional Study Examining Patient Characteristics and Reasons for Presentations.

Patricia A Poulin,Rebecca Small,Amanda Carson,Howard Nathan,Jennifer Nelli,Tia Carpino,Steven Tremblay,Heather Romanow,Monica Taljaard,Jeffrey Freeman,Yaadwinder Shergill,Yehudis Stokes,Ian G Stiell,Catherine E Smyth,Myka B Caluyong

doi:10.1155/2016/3092391

Abstract

Background. Chronic pain (CP) accounts for 10–16% of emergency department (ED) visits, contributing to ED overcrowding and leading to adverse events. Objectives. To describe patients with CP attending the ED and identify factors contributing to their visit. Methods. We used a mixed-method design combining interviews and questionnaires addressing pain, psychological distress, signs of opioid misuse, and disability. Participants were adults who attended the EDs of a large academic tertiary care center for their CP problem. Results. Fifty-eight patients (66% women; mean age 46.5, SD = 16.9) completed the study. The most frequently cited reason (60%) for ED visits was inability to cope with pain. Mental health problems were common, including depression (61%) and anxiety (45%). Participants had questions about the etiology of their pain, concerns about severe pain-related impairment, and problems with medication renewals or efficacy and sometimes felt invalidated in the ED. Although most participants had a primary care physician, the ED was seen as the only or best option when pain became unmanageable. Conclusions. Patients with CP visiting the ED often present with complex difficulties that cannot be addressed in the ED. Better access to interdisciplinary pain treatment is needed to reduce the burden of CP on the ED.

Highlights

Chronic pain (CP) is defined as pain that persists for more than 3 to 6 months or beyond the normal healing time [1] and it affects between 19 and 30% of the population in the USA, Canada, and Europe [2,3,4]
Patients' inability to cope with pain is the primary reason for
symptoms of posttraumatic stress were common in this group

Summary

Introduction

Chronic pain (CP) is defined as pain that persists for more than 3 to 6 months or beyond the normal healing time [1] and it affects between 19 and 30% of the population in the USA, Canada, and Europe [2,3,4]. Chronic pain accounts for 10–16% of emergency department (ED) visits [5, 6] with some patients relying heavily on emergency resources [7, 8]. The use of the ED may result in inconsistent or inappropriate care as well as adverse events [5, 15, 16] For all of these reasons, many jurisdictions are working to develop and evaluate programs designed to improve the quality of care and reduce the use of acute care resources for patients with chronic conditions [17] such as diabetes [18] or chronic obstructive pulmonary disease [19, 20]. Chronic pain (CP) accounts for 10–16% of emergency department (ED) visits, contributing to ED overcrowding and leading to adverse events.

Objectives

Methods

Discussion

Conclusion