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.
Alan Witkower, Ed.D.:
Alan Witkower, Ed.D.,is a Psychologist and the Assistant Director, Outpatient Pain Service, Associate Psychologist,, Department of Psychiatry, Massachusetts General Hospital, and Instructor in Psychology, Harvard Medical School
An essential part of work with patients with chronic pain involves teaching them techniques for coping with and managing their pain experience, including pain perception and pain behaviors. Having a strategy in place for managing an escalation of pain is part of this treatment. Some patients only have medications for flare-ups and have not been taught other means of pain relief. Patients who have these other fall-back measures will do better in an emergency.
I also think it is important for patients to be educated by their physicians when increased pain or a change in their pain represents an emergent issue, as opposed to when a pain flare-up can wait for a follow-up appointment or phone call to the physician. For example, increased pain associated with certain new neurological symptoms at the same time may warrant immediate attention.
I recommend to my patients to keep a packet together with their medication bottles, their list of medications, their pain contract, and the contact information for their doctors, to bring with them whenever they need an emergency medical visit. I also recommend that they tell the Emergency Department doctor what they think happened that caused the escalation in their pain and what they have attempted to do to manage the increased pain. The patient needs to provide the ED physician with sufficient information and at the same time not to be directing their care.
I think that what patients want as a “good outcome”, is to feel that they have had an appropriate physical examination, have been heard, believed and treated with respect, and in appropriate instances have been prescribed sufficient medication to provide relief until they can contact and be seen by their pain physician or primary care physician. I know that some hospitals have a protocol for their emergency department to “err on the side of treating and believing the patient’s report of pain”, and that makes sense to me and my patients.