Chronic Pain in the Emergency Department: A Pilot Mixed-Methods Cross-Sectional Study Examining Patient Characteristics and Reasons for Presentations.
Background. Chronic pain (CP) accounts for 10-16% of emergency department (ED) visits, contributing to ED overcrowding and leading to adverse events.Objectives. To describe patients with CP attending the ED and identify factors contributing to their visit.Methods. We used a mixed-method design combining interviews and questionnaires addressing pain, psychological distress, signs of opioid misuse, and disability. Participants were adults who attended the EDs of a large academic tertiary care center for their CP problem.Results. Fifty-eight patients (66% women; mean age 46.5, SD = 16.9) completed the study. The most frequently cited reason (60%) for ED visits was inability to cope with pain. Mental health problems were common, including depression (61%) and anxiety (45%). Participants had questions about the etiology of their pain, concerns about severe pain-related impairment, and problems with medication renewals or efficacy and sometimes felt invalidated in the ED. Although most participants had a primary care physician, the ED was seen as the only or best option when pain became unmanageable.Conclusions. Patients with CP visiting the ED often present with complex difficulties that cannot be addressed in the ED. Better access to interdisciplinary pain treatment is needed to reduce the burden of CP on the ED.
The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital Department of Psychology, Ottawa, ON, Canada.
Patricia A
0000-0002-3934-9870
PA
Poulin
Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada.
Jennifer
J
Nelli
Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada.
Steven
S
Tremblay
The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Faculty of Medicine, Memorial University, St. John's, NL, Canada.
Rebecca
0000-0001-8738-9503
R
Small
The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Myka B
MB
Caluyong
Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Jeffrey
J
Freeman
The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Heather
0000-0002-9435-1033
H
Romanow
Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; Carleton University, Ottawa, ON, Canada.
Yehudis
Y
Stokes
Carleton University, Ottawa, ON, Canada.
Tia
0000-0002-7485-408X
T
Carpino
Carleton University, Ottawa, ON, Canada; York University, Toronto, ON, Canada.
Amanda
0000-0001-9075-9368
A
Carson
The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Yaadwinder
0000-0002-4366-6713
Y
Shergill
The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Ian G
IG
Stiell
The Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada.
Monica
0000-0002-3978-8961
M
Taljaard
The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada.
Howard
H
Nathan
The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada.
Catherine E
CE
Smyth
D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010865:Pilot Projects; D011795:Surveys and Questionnaires