title: Patient Perspectives of Acute Pain Management in the Era of the Opioid Epidemic.
abstract: OBJECTIVE
  To inform the development of interventions that could improve patient engagement around the risks and benefits of alternative approaches to pain management in the emergency department (ED), we seek to capture the perspectives and experiences of patients treated for pain in this setting.
  
  
  METHODS
  Three trained interviewers conducted semistructured open-ended telephone interviews with patients discharged from a single urban academic ED after presenting with acute pain related to fracture, renal colic, or musculoskeletal back injury. We recruited subjects until achieving thematic saturation according to periodic review of the interview transcripts. Interviews were audio recorded, professionally transcribed, and uploaded into QSR NVivo (version 10.0) for coding and analysis using modified grounded theory. An interdisciplinary team double coded the data and convened to review emerging themes, ensure interrater reliability, and establish consensus on discrepancies.
  
  
  RESULTS
  We had 23 completed subject interviews, the majority of which were women. Interrater reliability for coding exceeded 90%. The major themes elicited centered on domains of patient awareness of the potential for opioid dependence and patient-provider communication relating to pain management. From the patient perspective, emergency physicians typically do not present alternative pain management options or discuss the risks of opioid dependence. Patients with negative experiences related to pain management describe deficiencies in patient-provider communication leading to misunderstanding of clinical diagnoses, fragmentation of care among their health care providers, and a desire to be involved in the decisionmaking process around their pain management. Patients with positive experiences commented on regular communication with their care team, rapid pain management, and the empathetic nature of their care providers. Patients communicate fears about the risks of opioid addiction, beliefs that following a prescribed opioid regimen is protective of developing opioid dependence, and an understanding of the broader tensions that providers face relating to the prescription of opioid therapy.
  
  
  CONCLUSIONS
  Patients identified a deficit of communication around opioid risk and pain management options in the ED.
authors: Center for Emergency Care Policy & Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors: Robert J
authors: RJ
authors: Smith
authors: Center for Emergency Care Policy & Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
authors: Karin
authors: K
authors: Rhodes
authors: Center for Emergency Care Policy & Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors: Breah
authors: B
authors: Paciotti
authors: Center for Emergency Care Policy & Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors: Sheila
authors: S
authors: Kelly
authors: Center for Emergency Care Policy & Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Medical Toxicology, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors: Jeanmarie
authors: J
authors: Perrone
authors: Center for Emergency Care Policy & Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. Electronic address: zfm@upenn.edu.
authors: Zachary F
authors: ZF
authors: Meisel
mesh_terms: D059787:Acute Pain / Q000188:drug therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003142:Communication; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D066296:Grounded Theory; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000209:etiology / Q000517:prevention & control; D059408:Pain Management / Q000009:adverse effects / Q000379:methods*; D010358:Patient Participation / Q000523:psychology; D055815:Young Adult