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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?

  1. Calm acceptance of the presentation with contextual management and physical comfort addressed (see flowchart)
  2. Elimination of red flags
  3. Assessment of yellow flags
  4. Understand the triggers that have resulted in presentation on this day
  5. Initiating appropriate treatment
  6. 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.

© Agency for Clinical Innovation 2023