Chronic pain management: American Society of Anesthesiologists Closed Claims Project.
BACKGROUND
The practice of chronic pain management has grown steadily in recent years. The purpose of this study was to identify and describe issues and trends in liability related to chronic pain management by anesthesiologists.


METHODS
Data from 5,475 claims in the American Society of Anesthesiologists Closed Claims Project database between 1970 and 1999 were reviewed to compare liability related to chronic pain management with that related to surgical and obstetric (surgical/obstetric) anesthesia. Acute pain management claims were excluded from analysis. Outcomes and liability characteristics between 284 pain management claims and 5,125 surgical/obstetric claims were compared.


RESULTS
Claims related to chronic pain management increased over time (P < 0.01) and accounted for 10% of all claims in the 1990s. Compensatory payment amounts were lower in chronic pain management claims than in surgical/obstetric anesthesia claims from 1970 to 1989 (P < 0.05), but during the 1990s, there was no difference in size of payments. Nerve injury and pneumothorax were the most common outcomes in invasive pain management claims. Epidural steroid injections accounted for 40% of all chronic pain management claims. Serious injuries, involving brain damage or death, occurred with epidural steroid injections with local anesthetics and/or opioids and with maintenance of implantable devices.


CONCLUSIONS
Frequency and payments of claims associated with chronic pain management by anesthesiologists increased in the 1990s. Brain damage and death were associated with epidural steroid injection only when opioids or local anesthetics were included. Anesthesiologists involved in home care of patients with implanted devices such as morphine pumps and epidural injections or patient-controlled analgesia should be aware of potential complications that may have severe outcomes.
Fitzgibbon
Dermot R
DR
Department of Anesthesiology, University of Washington, Seattle, 98195-6540, USA. dermot@u.washington.edu
Posner
Karen L
KL
Domino
Karen B
KB
Caplan
Robert A
RA
Lee
Lorri A
LA
Cheney
Frederick W
FW
D000328:Adult; D000758:Anesthesia / Q000009:adverse effects; D000767:Anesthesia, Epidural / Q000009:adverse effects; D000773:Anesthesia, Obstetrical / Q000009:adverse effects; D000776:Anesthesiology / Q000331:legislation & jurisprudence*; D002908:Chronic Disease; D004343:Drug Implants / Q000009:adverse effects; D005260:Female; D006801:Humans; D016365:Liability, Legal; D008318:Malpractice / Q000331:legislation & jurisprudence*; D010146:Pain / Q000517:prevention & control / Q000601:surgery; D059408:Pain Management; D010380:Peer Review; D011030:Pneumothorax / Q000209:etiology; D011247:Pregnancy; D013256:Steroids / Q000009:adverse effects
D004343:Drug Implants; D013256:Steroids