• Barth L Wilsey, Scott M Fishman, Christine Ogden, Alexander Tsodikov, and Klea D Bertakis.
• Department of Anesthesiology and Pain Medicine and VA Northern California Health Care System, University of California, Davis, California, USA. blwilsey@ucdavis.edu
• Pain Med. 2008 Nov 1;9(8):1073-80.

ObjectiveThe emergency department (ED) can be a particularly challenging environment in which to offer care for chronic pain. This study tried to determine if beliefs held by patients and providers about noncancer-related chronic pain affect evaluation and management of pain in ED.InterventionWe surveyed 103 patients presenting to the ED with chronic pain, 34 ED physicians, and 44 ED nurses to assess the influence of 15 possible barriers to managing chronic pain in the ED.ResultsPatients were significantly more likely than providers to believe that their pain had to have a diagnosed physical component to be treated. Providers were significantly more likely than patients to believe that patients came to the ED because they lacked a primary care physician. All agreed that chronic pain treatment was not a priority in the ED and the potential for addiction, dependence, diversion, and forged prescriptions was low.ConclusionsPatients in chronic pain may need to be reassured that their pain will be treated, even in the absence of objective signs or magnified symptoms. Providers may wrongly believe that lack of a primary care physician brings these patients to the ED. Providers and patients appear to believe that treating chronic pain in the ED has a low priority. Both groups may underestimate the problems inherent with prescribing opioids in this setting.

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