Chronic pain in the ED

There has been increasing awareness concerning the problem of acute pain in ED patients. There has, however, been little attention devoted to chronic pain in ED patients. Our purpose was to determine the extent and severity of chronic pain in adult ED patients. Adult noncritical patients were interviewed to determine if they had chronic pain. The Chronic Pain Grade scale was used to grade the severity of the pain. Four hundred seventy-six patients were enrolled. One hundred ninety-three (40.6%) had chronic pain. Sixty-five (13.7%) identified their chronic pain as the reason for the ED visit. The spine and abdomen were the most common sites of chronic pain. Those with chronic pain were more likely to be unemployed (relative risk [RR], 1.77; 95% confidence interval [CI], 1.34–2.34), disabled (RR, 3.24; 95% CI, 1.95–5.40), and have had four or more ED visits in the past year (RR, 2.47; 95% CI, 1.76–3.47). A total of 32.1% had class 3 pain (high disability, moderately limiting) and 58.0% had class 4 pain (high disability, severely limiting). Many noncritical ED patients have chronic pain. They are high users of ED services and most have not been seen in a pain clinic. Further studies are indicated to further delineate the demographics of this population and determine which patients would best be served in other healthcare settings. In an effort to improve care, ED physicians should be educated in diagnosing and treating chronic pain.