Chronic Pain in the ED
Chronic Pain
- Is pain persisting beyond 3 months.
- Is real but does not always reflect the extent of tissue damage.
- Is always influenced by central nervous system processes (including sensitisation, emotions, and thoughts) and the environmental context in which it occurs [1].
- Is commonly neuropathic, musculoskeletal or inflammatory in origin.
NOTE: Pain in patients with cancer may represent disease progression or development of significant complications, and may require investigation or input from treating specialist.
What is the problem?
- There has been a sixfold increase in frequent (>3 per year) chronic pain presentations to Emergency departments in NSW since 2010[2].
- Presentations are frequently associated with requests for medications (see Chronic Pain FAQs), particularly S8 drugs.
- Sometimes this can be a difficult and negative experience for both clinicians and consumers, can result in repeat presentations and inappropriate use of Ambulance services[3].
What can be done differently?
- Calm acceptance of the presentation with contextual management and physical comfort addressed (see flowchart)
- Elimination of red flags
- Assessment of yellow flags
- Understand the triggers that have resulted in presentation on this day
- Initiating appropriate treatment
- Establish a disposition plan and encourage plan for flare-up (APMA and PMN)
Further Reference and Resources
[1] Agency For Clinical Innovation. Management Principles for chronic non cancer pain. 2015.
[2] Han J. Pain in NSW Emergency Departments. Health Economics and Evaluation Team: Agency for Clinical Innovation; 2015.
[3] Donovan E, Ranney ML, Reid AM, Baird J, Green TC. Chronic Pain in the Emergency Department. Rhode Isl Med J 2017;100:25–9.
[4] The ACI Pain Management Network has released a new weblink for Aboriginal people who have pain and health workers who work with Aboriginal people.