The Challenges of Assessing Pain in a Busy Emergency Department

Author: Sophia Sheikh & Phylis Hendry

Pain is a significant component of emergency department (ED) chief complaints and by some estimates accounts for 78% of all visits. Managing pain in the ED and prehospital setting can be difficult due to a unique set of challenges and barriers compared to other healthcare environments. Emergency Departments treat an extremely diverse patient population, who present with a variety of acute and chronic pain complaints, accompanied by comorbidities from trauma to sickle cell crisis to diabetic neuropathy. Additionally, many ED patients have mental illness and or substance abuse histories. The ED can be an overcrowded high risk environment, especially during weekends, overnights, and holidays when primary care and pain clinics are closed. Further barriers adding to the complexity of ED pain management include:

  1. Limited clinician pain education (pharmacologic and nonpharmacologic)
  2. Lack of resources and time to verify patient histories and prescriptions
  3. Difficulty differentiating drug-seeking and drug-diverting behavior from true legitimate pain
  4. Balancing analgesia and sedation with adverse effects
  5. Differentiating pain from anxiety
  6. Pressure to rapidly disposition patients while... 

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