Chronic Pain Worse among Emergency Department Patients

Article excerpt

CHICAGO -- Emergency department patients with a history of chronic pain rate their pain as more severe than acute pain patients do, based on a prospective, observational study conducted in 20 emergency departments, said Dr. Martha L. Neighbor at the annual meeting of the Society for Academic Emergency Medicine.

Furthermore, chronic pain associated with headache, migraine, back pain, cancer, sickle cell disease, substance abuse, and psychiatric disorders is highly prevalent in the ED, said Dr. Neighbor of San Francisco General Hospital and professor of medicine at the University of California, San Francisco.

Most of the 50 million Americans with chronic pain will have breakthrough pain, and many will seek ED care, Dr. Neighbor said in an interview, adding that little is known about this subgroup of patients.

In a prospective, observational study of 246 chronic pain patients and 389 acute pain patients at 20 EDs in the United States and Canada, patients with chronic pain had dissatisfaction scores of 4.9%, compared with dissatisfaction scores of 4.7% for those patients with acute pain.

Data were derived from structured interviews, medical record abstraction, and telephone follow-up. All patients had moderate to severe pain (numerical rating scale, or NRS, of 4 or greater on a scale of 10) and were enrolled during six 8-hour shifts over 2-week periods with all shifts of the 24-hour cycle represented, Dr. Neighbor explained.

When the patients were asked why they came to the ED, 56% said they were there because of chronic pain, which was defined as continuous or intermittent pain of 1 month or longer duration, she said. …