title: Prevalence and treatment of pain in EDs in the United States, 2000 to 2010.
abstract: OBJECTIVE
  To describe changes in the prevalence and severity of pain and prescribing of non-opioid analgesics in US emergency departments (EDs) from 2000 to 2010.
  
  
  METHODS
  Analysis of serial cross-sectional data regarding ED visits from the National Hospital Ambulatory Medical Care Survey. Visits were limited to patients ≥18 years old without malignancy. Outcome measures included annual volume of visits among adults with a primary symptom or diagnosis of pain, annual rates of patient-reported pain severity, and predictors of non-opioid receipt for non-malignant pain.
  
  
  RESULTS
  Rates of pain remained stable, representing approximately 45% of visits from 2000 through 2010. Patients reported pain as their primary symptom twice as often as providers reported a primary pain diagnosis (40% vs 20%). The percentage of patients reporting severe pain increased from 25% (95% confidence intervals [CI] 22%-27%) in 2003 to 40% (CI 37%-42%) in 2008. From 2000 to 2010, the proportion of pain visits treated with pharmacotherapies increased from 56% (CI 53%-58%) to 71% (CI 69%-72%), although visits treated exclusively with non-opioids decreased 21% from 28% (CI 27%-30%) to 22% (CI 20%-23%). The adjusted odds of non-opioid rather than opioid receipt were greater among visits for patients 18 to 24 years old (odds ratio [OR] 1.35, CI 1.24-1.46), receiving fewer medicines (OR 2.91, CI 2.70-3.15) and those with a diagnosis of mental illness (OR 2.24, CI 1.99-2.52).
  
  
  CONCLUSIONS
  Large increases in opioid utilization in EDs have coincided with reductions in the use of non-opioid analgesics and an unchanging prevalence of pain among patients.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Hsien-Yen
authors.initials: HY
authors.lastname: Chang
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Daubresse
authors.affiliation: Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA; Stefan P. Kruszewski, M.D. & Associates, Harrisburg, PA, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Kruszewski
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA; Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA. Electronic address: galexand@jhsph.edu.
authors.forename: G Caleb
authors.initials: GC
authors.lastname: Alexander
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology* / Q000517:prevention & control*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D014481:United States / Q000453:epidemiology
chemical_list: D000700:Analgesics