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Alan Witkower, Ed.D.

Jim Broatch, MSW

Knox Todd, MD

Rochelle Odell

Pain and the Emergency Department Part 2

What education is provided to ED staff about the management of acute and chronic pain and what advice would you give a chronic pain patient or their primary care provider to help prepare for a good response during an ED visit?

Learn about critical pain issues from experts.

Read part 2 of ”Pain and the Emergency Department” to better understand how professionals have dealt with chronic pain patients in the ED.

Knox Todd, MD:

Knox Todd, MD, is the Director of the Pain and Emergency Medicine Institute, Department of Emergency Medicine, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY, and the author of many publications on pain management.

The specialty of Emergency Medicine is relatively new; it is only about 25 years old. There is increasing recognition of the need to provide all emergency medicine physicians with more education about pain management. Emergency Departments in urban areas tend to have more specifically trained, board-certified emergency physicians. In other places, especially more rural areas, physicians who work in an emergency room are not board certified in Emergency Medicine, may work there part time, or may be part of a contracted service.

In terms of analgesic use, the good news is that the National Center on Health Statistics between 1997 and 2001, reported an 18% increase in the use of analgesics in U.S. Emergency Departments. That is a huge increase in only four years, and I believe it is largely due to education of Emergency Department staff about the problem of under treated pain.

To improve the care they will receive, it certainly helps if there is direct communication between the patient’s primary care provider and the Emergency Department, in advance of the patient’s visit, or during the visit. It is a good idea for chronic pain patients to bring with them succinct documentation of their diagnosis and current treatment plan, and to state clearly what their problem is, i.e., “I am a chronic pain patient with an effective management plan but due to X event I have had an acute exacerbation of my pain”. When patients tell the Emergency Department staff that they are seeking potent opioids, it may raise a “red flag”. A better way to give this information is to describe what has been used in the past, what has been found to be helpful, and what was found to not be helpful.


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