CHICAGO – Emergency department patients with a history of chronic pain rate their pain as more severe than acute pain patients do, based on a prospective, observational study conducted in 20 emergency departments, said Dr. Martha L. Neighbor at the annual meeting of the Society for Academic Emergency Medicine.
Furthermore, chronic pain associated with headache, migraine, back pain, cancer, sickle cell disease, substance abuse, and psychiatric disorders is highly prevalent in the ED, said Dr. Neighbor of San Francisco General Hospital and professor of medicine at the University of California, San Francisco.
Most of the 50 million Americans with chronic pain will have breakthrough pain, and many will seek ED care, Dr. Neighbor said in an interview, adding that little is known about this subgroup of patients.
In a prospective, observational study of 246 chronic pain patients and 389 acute pain patients at 20 EDs in the United States and Canada, patients with chronic pain had dissatisfaction scores of 4.9%, compared with dissatisfaction scores of 4.7% for those patients with acute pain.
Data were derived from structured interviews, medical record abstraction, and telephone follow-up. All patients had moderate to severe pain (numerical rating scale, or NRS, of 4 or greater on a scale of 10) and were enrolled during six 8-hour shifts over 2-week periods with all shifts of the 24-hour cycle represented, Dr. Neighbor explained.
When the patients were asked why they came to the ED, 56% said they were there because of chronic pain, which was defined as continuous or intermittent pain of 1 month or longer duration, she said.
Patients with chronic pain had significantly more severe pain at all time measurements, from arrival in the ED through discharge to a 1-week telephone follow-up. On arrival in the ED, the median NRS was 8.0 in the chronic pain group and 7.5 in the acute pain group. On discharge, the pain ratings were 6.1 and 5.2, respectively. And at follow-up, they were 3.7 and 2.1, respectively.
In examining analgesia differences, the investigators found that patients with chronic pain were more likely than patients with acute pain to:
▸ Feel the need for analgesics (77% vs. 67%).
▸ Ask for analgesics (33% vs. 22%).
▸ Report that they have allergies to analgesics (19% vs. 5%).
▸ Take analgesics both at ED presentation (37% vs. 17%) and at follow-up (87% vs. 79%).
“Patients with chronic pain are experiencing more severe pain than acute pain patients do,” Dr. Neighbor said in an interview.
Because they typically are taking analgesics, they “may be more challenging to deal with as far as improving their pain care is concerned.”
Fortunately, at least in the ED setting, those patients are just as likely as acute pain sufferers to receive analgesics. Whether improvements in ED pain management practice will lead to better outcomes in this population is unknown, she concluded.