Introduction

Background

There are approximately 150 million emergency department (ED) visits in the United States (US) annually.1 Pain is the most common reason for seeking care in the emergency setting and accounts for nearly three-quarters of chief complaints.2, 3, 4 Among patients presenting to the ED with pain-related conditions, the level of reported pain is often significant, with an estimated 70-75% of patients describing moderate-to-severe pain.5 Pain relief may remain inadequate even when analgesics are administered in the ED. In a large multicenter study, 75% of patients presenting to the ED with moderate-to-severe pain continued to experience moderate-to-severe pain at discharge despite treatment.6 Inadequately managed acute pain is also associated with increased health care resource utilization and costs,7 including repeat ED visits for the same episode of pain.8,9

Importance

Insufficient relief from acute pain can substantially affect patients’ health and wellbeing, including prolonged recovery, impaired sleep and mood, interference with ambulation and activities of daily living (ADLs), difficulty returning to work or maintaining productivity, and increased risk of developing chronic pain.10, 11, 12, 13, 14 Poorly controlled acute pain in older adults has also been associated with adverse health outcomes such as delirium.15 In the ED, inadequate pain relief has also been associated with longer ED stays, prolonged inpatient stays among admitted patients, and mortality.16

Prior qualitative research suggests that patients seeking acute pain relief in ED settings have concerns about opioid addiction, value clear patient-provider communication, and want involvement in treatment decisions.17,18 These studies also describe challenges after discharge, including underuse of prescribed opioids because of dependence concerns and difficulties obtaining follow-up care or medication refills despite continued pain.17

Goals of this Investigation

Acute pain management is complex, and emergency physicians (EPs) must balance effective pain relief with patient safety in routine clinical practice.19 To manage acute pain, EPs administer or prescribe analgesics with different mechanisms of action, commonly including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen. Multimodal analgesia, which combines both opioids and nonopioid treatments, may improve pain control while reducing adverse effects.20 However, there is limited understanding of how EPs experience the challenges and barriers associated with acute pain management in the ED. To address this evidence gap, interviews were conducted with a sample of US-based EPs to characterize experiences and unmet needs associated with acute pain management in the ED.