title: The role of the emergency department in the acute management of chronic or recurrent pain.
abstract: BACKGROUND
  Exacerbation of chronic pain is a common presenting problem for patients attending emergency departments (EDs), with many making multiple visits.
  
  
  OBJECTIVE
  This paper aims to identify the role of the ED in the acute management of patients with persistent or chronic nonmalignant pain through a review of current literature.
  
  
  METHODS
  Four databases were searched using the MeSH and subject search terms "chronic nonmalignant pain", "persistent pain" and "emergency" and synonyms associated with these terms. Literature related to the underlying causes of suboptimal chronic pain management along with the sequelae associated with treatment or management was extracted.
  
  
  RESULTS
  Three main themes emerged: patient expectations and satisfaction, barriers to care, and strategies/principles to improve ED management for this patient group. The presence of these themes appears to be partially due to time limitations for chronic issues in an acute department, accompanied by a lack of clear guidelines.
  
  
  CONCLUSIONS
  It is evident that the ED is not the ideal setting for managing patients with chronic pain however it is the last resort for many who do present, and who will continue to present should their pain persist. It is time to ensure that the ED provides a consistently supportive, cohesive and integrated approach to managing patients with chronic pain syndromes.
authors.affiliation: Emergency Department, Nelson Public Hospital, Nelson, New Zealand. diane.mcleod@nmhs.govt.nz
authors.forename: Diane
authors.initials: D
authors.lastname: McLeod
authors.forename: Katherine
authors.initials: K
authors.lastname: Nelson
mesh_terms: D059350:Chronic Pain / Q000451:nursing / Q000517:prevention & control; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D004638:Emergency Treatment / Q000451:nursing; D006801:Humans; D010146:Pain / Q000451:nursing / Q000517:prevention & control*; D010147:Pain Measurement / Q000451:nursing; D017410:Practice Guidelines as Topic; D055502:Secondary Prevention