Pain Care Management in the Emergency Department: A Retrospective Study to Examine One Program's Effectiveness

IntroductionNo clear consensus exists regarding the most appropriate approach to reducing repetitive ED visits for pain complaints. These visits create a burden on health care resources and may contribute to inappropriate and excessive use of opioid medications. The purpose of this study was to examine the pain management program in 1 emergency department (1) to determine whether ED visits significantly decreased among program enrollees; (2) to quantify program interventions applied to enrollees; and (3) to explore relationships between enrollee characteristics (sex, age, comorbidities, health coverage plans) and the program's interventions and outcomes.MethodsA retrospective, descriptive, correlational design was used to examine the medical records of 134 patients who were enrolled in a pain care management program during a 1-year period.ResultsStudy subjects' ED visits were reduced by 77%, from 3,689 total visits during the pre-enrollment year to 852 in the post-enrollment year (P < .001). As a result of the program, patients were referred to primary care providers (58%), addiction specialists (14%), dentists (4%), neurosurgeons (4%), and neurologists (4%). The most common pain management program interventions were narcotic restriction (65%), establishment of a non-narcotic treatment regimen (57%), and enactment of a “1 pharmacy/1 provider” restriction (23%).DiscussionThis study supports existing evidence that patients with an excessive number of ED visits for pain-related complaints can be managed with a proactive pain care management program that includes coordination with a primary care provider and a supportive ED medical staff.