Hostname: page-component-7c8c6479df-xxrs7 Total loading time: 0 Render date: 2024-03-28T20:23:11.601Z Has data issue: false hasContentIssue false

Chronic Pain and Aberrant Drug-Related Behavior in the Emergency Department

Published online by Cambridge University Press:  01 January 2021

Extract

Pain is the single most common reason patients seek care in the emergency department. Given the prevalence of pain as a presenting complaint, one might expect emergency physicians to assign its treatment a high priority; however, pain is often seemingly invisible to the emergency physician. Multiple research studies have documented that the undertreatment of pain, or oligoanalgesia, is a frequent occurrence. Pain that is not acknowledged and managed appropriately causes dissatisfaction with medical care, hostility toward the physician, unscheduled returns to the emergency department, delayed return to full function, and potentially, an increased risk of litigation. Failure to recognize and treat pain may result in anxiety, depression, sleep disturbances, increased oxygen demands with the potential for end organ ischemia, and decreased movement with an increased risk of venous thrombosis.

Type
Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Cordell, W. H., Keene, K. K., Giles, B. K., Jones, J. B., Jones, J. H. and Brizendine, E. J., “The High Prevalence of Pain in Emergency Medical Care,” American Journal of Emergency Medicine 20 (2002): 165169.CrossRefGoogle Scholar
Rupp, T. and Delaney, K. A., “Inadequate Analgesia in Emergency Medicine,” Annals of Emergency Medicine 43 (2004): 494503, at 495.CrossRefGoogle Scholar
Portenoy, R. K., Ugarte, C., Fuller, I. and Haas, G., “Population-Based Survey of Pain in the United States: Differences among White, African American, and Hispanic Subjects,” Journal of Pain 5 (2004): 317328, at 319.CrossRefGoogle Scholar
Verhaak, P. F., Kerssens, J. J., Dekker, J., Sorbi, M. J. and Bensing, J. M., “Prevalence of Chronic Benign Pain Disorder among Adults: A Review of the Literature,” Pain 77 (1998): 231239, at 234CrossRefGoogle Scholar
Johnston, C. C., Gagnon, A. J., Fullerton, L., Common, C., Ladores, M., Forlini, S., “One-Week Survey of Pain Intensity on Admission to and Discharge from the Emergency Department: A Pilot Study,” Journal of Emergency Medicine 16 (1998): 377382.CrossRefGoogle Scholar
Tanabe, P. and Buschmann, M., “A Prospective Study of ED Pain Management Practices and the Patient's Perspective,” Journal of Emergency Nursing 25 (1999): 171177.CrossRefGoogle Scholar
Cordell, , supra note 1.Google Scholar
Todd, K. H., Ducharme, J., Choiniere, M., Johnston, C., Crandall, C., Puntillo, K., “Pain and Pain-Related Functional Interference among Discharged Emergency Department Patients,” (abstract) Annals of Emergency Medicine 44 (2004): S86.CrossRefGoogle Scholar
American Psychiatric Association, Diagnostic and Statistical Manual for Mental Disorders – IV (Washington, DC: American Psychiatric Association, 1994).Google Scholar
Rinaldi, R. C., Steindler, E. M., Wilford, B. B. and Goodwin, D., “Clarification and Standardization of Substance Abuse Terminology,” JAMA 259 (1988): 555557CrossRefGoogle Scholar
Substance Abuse and Mental Health Services Administration, Overview of Findings from the 2003 National Survey on Drug Use and Health (Office of Applied Studies, NSDUH Series H-24, DHHS Publication No. SMA 04–3963, Rockville, MD, 2004).Google Scholar
Soderstrom, C. A., Smith, G. S., Dischinger, P. C., McDuff, D. R., Hebel, J. R., Gorelick, D. A., Kerns, T. J., Ho, S. M. and Read, K. M., “Psychoactive Substance use Disorders among Seriously Injured Trauma Center Patients,” JAMA 277 (1997): 1769–74.CrossRefGoogle Scholar
Spitzer, R. L., Williams, J. B. W., Gibbon, M., First, M. B., Structured Clinical Interview for DSM-III-R, Patient Edition/Non-patient Edition (SCID-P/SCID-NP) (Washington, DC: American Psychiatric Press, Inc., 1990).Google Scholar
Rockett, I. R., Putnam, S. L., Jia, H. and Smith, G. S., “Assessing Substance Abuse Treatment Need: A Statewide Hospital Emergency Department Study,” Annals of Emergency Medicine 41 (2003): 802–13, at 803.CrossRefGoogle Scholar
Rockett, I. R., Putnam, S. L., Jia, H., Chang, C. F. and Smith, G. S., “Unmet Substance Abuse Treatment Need, Health Services Utilization, and Cost: A Population-Based Emergency Department Study,” Annals of Emergency Medicine 45 (2005): 118–27, at 119.CrossRefGoogle Scholar
Hansen, G. R., “The Drug-Seeking Patient in the Emergency Room,” Emergency Medicine Clinics of North America 23 (2005): 349365, at 349.CrossRefGoogle Scholar
Zechnich, A. D. and Hedges, J. R., “Community-Wide Emergency Department Visits by Patients Suspected of Drug-Seeking Behavior,” Academic Emergency Medicine 3 (1996): 312317, at 312.CrossRefGoogle Scholar
SAMHSA, supra note 12.Google Scholar
Graber, M. A., Gjerde, C., Bergus, G., Ely, J., “The Use of Unofficial ‘Problem Patient’ Files and Interinstitutional Information Transfer in Emergency Medicine in Iowa,” American Journal of Emergency Medicine 13 (1995): 509–11.CrossRefGoogle Scholar
Pope, D., Fernandes, C. M., Bouthillette, F. and Etherington, J., “Frequent Users of the Emergency Department: A Program to Improve Care and Reduce Visits,” Canadian Medical Association Journal 162 (2000): 1017–20.Google Scholar
Geiderman, J. M., “Keeping Lists and Naming Names: Habitual Patient Files for Suspected Nontherapeutic Drug-Seeking Patients,” Annals of Emergency Medicine 41 (2003): 873881, at 874.CrossRefGoogle Scholar
Selbst, S. M. and Clark, M., “Analgesic Use in the Emergency Department,” Annals of Emergency Medicine 19 (1990): 1010–3; Lewis, L. M., Lasater, L. C. and Brooks, C. B., “Are Emergency Physicians too Stingy with Analgesics?” Southern Medical Journal 87 (1994): 7–9; Petrack, E. M., Christopher, N. C., Kriwinsky, J., “Pain Management in the Emergency Department: Patterns of Analgesic Utilization,” Pediatrics 99 (1997): 711–714; Singer, A. J., Konia, N., “Comparison of Topical Anesthetics and Vasoconstrictors vs. Lubricants Prior to Nasogastric Intubation: A Randomized, Controlled Trial,” Academic Emergency Medicine 6 (1999): 184–190, at 184; Fosnocht, D. E., Swanson, E. R. and Bossart, P., “Patient Expectations for Pain Medication Delivery,” American Journal of Emergency Medicine 19 (2001): 399–402.CrossRefGoogle Scholar
Hay, J. L. and Passik, S. D., “The Cancer Patient with Borderline Personality Disorder: Suggestions for Symptom-Focused Management in the Medical Setting,” Psycho Oncology 9 (2000): 91100, at 98.3.0.CO;2-8>CrossRefGoogle Scholar
Linklater, D. R., Pemberton, L., Taylor, S. and Zeger, W., “Painful Dilemmas: An Evidence-Based Look at Challenging Clinical Scenarios,” Emergency Medicine Clinics of North America 23 (2005): 367392, at 378.CrossRefGoogle Scholar
Yale, S. H., Nagib, N. and Guthrie, T., “Approach to the Vaso-Occlusive Crisis in Adults with Sickle Cell Disease. American Family Physician 61 (2000): 1349–56, 1363–4.Google Scholar
Shapiro, B. S., Benjamin, L. J., Payne, R. and Heidrich, G., “Sickle Cell-Related Pain: Perceptions of Medical Practitioners,” Journal of Pain & Symptom Management 14 (1997): 168174, at 173.CrossRefGoogle Scholar
Pack-Mabien, A., Labbe, E., Herbert, D. and Haynes, J. Jr., “Nurses' Attitudes and Practices in Sickle Cell Pain Management,” Applied Nursing Research 14 (2001): 187192, at 190.CrossRefGoogle Scholar
Brookoff, D. and Polomano, R., “Treating Sickle Cell Pain like Cancer Pain,” Annals of Internal Medicine 116 (1992): 364368, at 367.CrossRefGoogle Scholar
Shaiova, L. and Wallenstein, D., “Outpatient Management of Sickle Cell Pain with Chronic Opioid Pharmacotherapy,” Journal of the National Medical Association 96 (2004): 984986.Google Scholar
Gureje, O., Von Korff, M., Simon, G. E., Gater, R., “Persistent Pain and Well-Being: A World Health Organization Study in Primary Care,” JAMA 280 (1998): 147151, at 151.CrossRefGoogle Scholar
Tse, S. K., Wong, T. W., Lau, C. C., Yeung, W. S., Tang, W. N., “How Good are Accident and Emergency Doctors in the Evaluation of Psychiatric Patients?” European Journal of Emergency Medicine 6 (1999): 297300, at 297.CrossRefGoogle Scholar
ACEP Board of Directors, “Policy Statement: Pain Management in the Emergency Department,” Annals of Emergency Medicine 44 (2004): 198.Google Scholar