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

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.

Depression Linked to Frequent Emergency Department Use in Large 10-year Retrospective Analysis of an Integrated Health Care System

“…In many cases, patients may be exhibiting somatic manifestations of depression or may be experiencing exacerbation of medical conditions due to a psychiatric illness that is not optimally controlled [6,14,15,18]. Our findings are consistent with previous reports in showing that depression-associated ED use is often seen in the form of various types of chronic pain [3,12,19]. These reports demonstrate that depression is associated with worse prognosis and increased ED usage in abdominal pain, headaches, and general chronic pain conditions.…”

“…Emergency Departments (ED) are designed to provide patients immediate, unscheduled medical care for acute illnesses and injuries. However, frequent revisits to the ED by a small percentage of patients with chronic conditions or complaints contribute to long wait times and delayed admission of those with critical needs [1][2][3][4][5][6][7][8][9]. Many studies have implicated depression as a strong predictor of those that present to the ED, especially with complaints of acute or chronic pain and those who present with high frequency [10][11][12][13][14][15][16][17].…”

The Acute Care of Chronic Pain Study: Perceptions of Acute Care Providers on Chronic Pain, a Social Media-based Investigation

“…Further studies suggest that ED patients find deficits in physician communication in pain management and opioid risk options [ 6 ]. A recent mixed-methods study performed by Poulin et al have concluded that chronic pain patients’ dissatisfaction with the care offered to them stems from the rapid pace of assessment and treatment in the ED being suboptimal for the effective treatment of chronic pain [ 7 ]. Given the high prevalence and associated cost of ED visits related to chronic pain, it is worthwhile to examine potential care provider factors contributing to the suboptimal care and established patient dissatisfaction.…”

Controlled clinical trial of canine therapy versus usual care to reduce patient anxiety in the emergency department

“…[26, 27] At least 40% of ED patients with medically unexplained or chronic pain have moderate to severe situational anxiety, and a larger fraction admit to severe chronic stress. [1, 3, 28] Challenges to initiating therapy dogs include the administrative hurdles required to obtain hospital credentials for therapy dogs and handlers to visit the ED, including “worst-case” concerns over possible patient phobias for dogs, allergies, zoonotic infections, and hygiene. Other challenges include the fact that dogs and handlers are not uniformly available, yet EDs are always open.…”