Table of Contents Author Guidelines Submit a Manuscript
Pain Research and Management
Volume 2016, Article ID 3092391, 10 pages
http://dx.doi.org/10.1155/2016/3092391
Research Article

Chronic Pain in the Emergency Department: A Pilot Mixed-Methods Cross-Sectional Study Examining Patient Characteristics and Reasons for Presentations

1The Ottawa Hospital Research Institute, Ottawa, ON, Canada
2Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada
3The Ottawa Hospital Department of Psychology, Ottawa, ON, Canada
4Faculty of Medicine, Memorial University, St. John’s, NL, Canada
5Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
6Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
7Carleton University, Ottawa, ON, Canada
8York University, Toronto, ON, Canada
9School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada

Received 21 October 2015; Revised 10 August 2016; Accepted 6 September 2016

Academic Editor: Celeste C. Johnston

Copyright © 2016 Patricia A. Poulin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. “Task force on taxonomy of the international association for the study of pain,” in Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms, H. Merskey and N. Bogduk, Eds., IASP Press, Seattle, Wash, USA, 1994.
  2. C. B. Johannes, T. K. Le, X. Zhou, J. A. Johnston, and R. H. Dworkin, “The prevalence of chronic pain in united states adults: results of an internet-based survey,” Journal of Pain, vol. 11, no. 11, pp. 1230–1239, 2010. View at Publisher · View at Google Scholar · View at Scopus
  3. H. Breivik, B. Collett, V. Ventafridda, R. Cohen, and D. Gallacher, “Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment,” European Journal of Pain, vol. 10, no. 4, pp. 287–333, 2006. View at Publisher · View at Google Scholar · View at Scopus
  4. D. Schopflocher, P. Taenzer, and R. Jovey, “The prevalence of chronic pain in Canada,” Pain Research and Management, vol. 16, no. 6, pp. 445–450, 2011. View at Publisher · View at Google Scholar · View at Scopus
  5. K. H. Todd, P. Cowan, N. Kelly, and P. Homel, “Chronic or recurrent pain in the emergency department: national telephone survey of patient experience,” The Western Journal of Emergency Medicine, vol. 11, no. 5, pp. 408–415, 2010. View at Google Scholar
  6. A. M. Bernard and S. W. Wright, “Chronic pain in the ED,” American Journal of Emergency Medicine, vol. 22, no. 6, pp. 444–447, 2004. View at Publisher · View at Google Scholar · View at Scopus
  7. B. L. Wilsey, S. M. Fishman, A. Tsodikov, C. Ogden, I. Symreng, and A. Ernst, “Psychological comorbidities predicting prescription opioid abuse among patients in chronic pain presenting to the emergency department,” Pain Medicine, vol. 9, no. 8, pp. 1107–1117, 2008. View at Publisher · View at Google Scholar · View at Scopus
  8. K. H. Todd, J. Ducharme, M. Choiniere, C. Johnson, C. Crandall, and K. Puntillo, “Pain and pain-related functional interference among discharged emergency department patients,” Annals of Emergency Medicine, vol. 44, no. 4, p. S86, 2004. View at Publisher · View at Google Scholar
  9. B. L. Wilsey, S. M. Fishman, M. Crandall, C. Casamalhuapa, and K. D. Bertakis, “A qualitative study of the barriers to chronic pain management in the ED,” American Journal of Emergency Medicine, vol. 26, no. 3, pp. 255–263, 2008. View at Publisher · View at Google Scholar · View at Scopus
  10. K. Baker, “Chronic pain syndromes in the emergency department: identifying guidelines for management,” Emergency Medicine Australasia, vol. 17, no. 1, pp. 57–64, 2005. View at Publisher · View at Google Scholar · View at Scopus
  11. R. G. Weaver, B. J. Manns, M. Tonelli et al., “Access to primary care and other health care use among western Canadians with chronic conditions: a population-based survey,” CMAJ Open, vol. 2, no. 1, pp. E27–E34, 2014. View at Publisher · View at Google Scholar
  12. T. D. Moon, M. B. Laurens, S. M. Weimer, and J. A. Levy, “Nonemergent emergency room utilization for an inner-city pediatric population,” Pediatric Emergency Care, vol. 21, no. 6, pp. 363–366, 2005. View at Publisher · View at Google Scholar · View at Scopus
  13. D. K. Padgett and B. Brodsky, “Psychosocial factors influencing non-urgent use of the emergency room: a review of the literature and recommendations for research and improved service delivery,” Social Science and Medicine, vol. 35, no. 9, pp. 1189–1197, 1992. View at Publisher · View at Google Scholar · View at Scopus
  14. Canadian Institute for Health Information, Hospital Cost Drivers Technical Report—What Factors Have Determined Hospital Expenditure Trends in Canada?Canadian Institute for Health Information. Hospital Cost Drivers, Ottawa, Canada, 2012, https://www.cihi.ca/en/hospital_costdriver_tech_en.pdf.
  15. D. B. MacLeod and R. Swanson, “A new approach to chronic pain in the ED,” American Journal of Emergency Medicine, vol. 14, pp. 323–326, 1996. View at Google Scholar
  16. I. A. Dhalla, M. M. Mamdani, M. L. A. Sivilotti, A. Kopp, O. Qureshi, and D. N. Juurlink, “Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone,” Canadian Medical Association Journal, vol. 181, no. 12, pp. 891–896, 2009. View at Publisher · View at Google Scholar · View at Scopus
  17. Canadian Foundation for Healthcare Improvement, The Impact on Emergency Department Utilization of the CFHI Healthcare Collaborations and Initiatives, Canadian Foundation for Healthcare Improvement, Ottawa, Canada, 2013.
  18. M. B. Davidson, A. Ansari, and V. J. Karlan, “Effect of a nurse-directed diabetes disease management program on urgent care/emergency room visits and hospitalizations in a minority population,” Diabetes Care, vol. 30, no. 2, pp. 224–227, 2007. View at Publisher · View at Google Scholar · View at Scopus
  19. E. Dajczman, C. Robitaille, P. Ernst et al., “Integrated interdisciplinary care for patients with chronic obstructive pulmonary disease reduces emergency department visits and admissions: a quality assurance study,” Canadian Respiratory Journal, vol. 20, no. 5, pp. 351–356, 2013. View at Publisher · View at Google Scholar · View at Scopus
  20. Ministry of Health and Long Term Care, Preventing and Managing Chronic Disease: Ontario's Framework, 2007, http://www.health.gov.on.ca/en/pro/programs/cdpm/pdf/framework_full.pdf.
  21. J. Gauntlett-Gilbert, K. Rodham, A. Jordan, and P. Brook, “Emergency department staff attitudes toward people presenting in chronic pain: a qualitative study,” Pain Medicine, vol. 16, no. 11, pp. 2065–2074, 2015. View at Publisher · View at Google Scholar · View at Scopus
  22. J. Jambunathan, S. Chappy, J. J. Siebers, and A. Deda, “Patient-centered care for chronic pain in the emergency department: a qualitative study,” International Emergency Nursing, vol. 24, pp. 22–27, 2016. View at Publisher · View at Google Scholar
  23. The Ottawa Hospital, The Ottawa Hospital's Annual Report 2013-2014, The Ottawa Hospital, Ottawa, Canada, 2014.
  24. G. Tan, M. P. Jensen, J. I. Thornby, and B. F. Shanti, “Validation of the brief pain inventory for chronic nonmalignant pain,” Journal of Pain, vol. 5, no. 2, pp. 133–137, 2004. View at Publisher · View at Google Scholar · View at Scopus
  25. M. J. L. Sullivan, S. R. Bishop, and J. Pivik, “The pain catastrophizing scale: development and validation,” Psychological Assessment, vol. 7, no. 4, pp. 524–532, 1995. View at Publisher · View at Google Scholar · View at Scopus
  26. S. F. Butler, K. Fernandez, C. Benoit, S. H. Budman, and R. N. Jamison, “Validation of the revised screener and opioid assessment for patients with pain (SOAPP-R),” Journal of Pain, vol. 9, no. 4, pp. 360–372, 2008. View at Publisher · View at Google Scholar · View at Scopus
  27. K. Kroenke, R. L. Spitzer, and J. B. W. Williams, “The PHQ-9: validity of a brief depression severity measure,” Journal of General Internal Medicine, vol. 16, no. 9, pp. 606–613, 2001. View at Publisher · View at Google Scholar · View at Scopus
  28. R. L. Spitzer, K. Kroenke, J. B. W. Williams, and B. Löwe, “A brief measure for assessing generalized anxiety disorder: the GAD-7,” Archives of Internal Medicine, vol. 166, no. 10, pp. 1092–1097, 2006. View at Publisher · View at Google Scholar · View at Scopus
  29. D. Conybeare, E. Behar, A. Solomon, M. G. Newman, and T. D. Borkovec, “The PTSD checklist-civilian version: reliability, validity, and factor structure in a nonclinical sample,” Journal of Clinical Psychology, vol. 68, no. 6, pp. 699–713, 2012. View at Publisher · View at Google Scholar · View at Scopus
  30. C. H. Bastien, A. Vallières, and C. M. Morin, “Validation of the insomnia severity index as an outcome measure for insomnia research,” Sleep Medicine, vol. 2, no. 4, pp. 297–307, 2001. View at Publisher · View at Google Scholar · View at Scopus
  31. IBM SPSS Statistics for Windows, IBM, Armonk, NY, USA, 2011.
  32. R. H. Browne, “On the use of a pilot sample for sample size determination,” Statistics in Medicine, vol. 14, no. 17, pp. 1933–1940, 1995. View at Publisher · View at Google Scholar · View at Scopus
  33. G. J. Hahn and W. Q. Meeker, Statistical Intervals, John Wiley & Sons, New York, NY, USA, 1991.
  34. H. Ando, C. Young, and R. Cousins, “Achieving saturation in thematic analysis: development and refinement of a codebook,” Comprehensive Psychology, vol. 3, no. 4, 2014. View at Publisher · View at Google Scholar
  35. NVivo Qualitative Data Analysis Software, QSR International Pty Ltd, Melbourne, Australia, 2012.
  36. V. Braun and V. Clarke, “Using thematic analysis in psychology,” Qualitative Research in Psychology, vol. 3, no. 2, pp. 77–101, 2006. View at Publisher · View at Google Scholar · View at Scopus
  37. G. Guest, K. MacQueen, and E. Namey, “Introduction to applied thematic analysis,” in Applied Thematic Analysis, pp. 3–20, Sage, Thousand Oaks, Calif, USA, 2012. View at Google Scholar
  38. M. F. P. Peres and G. Lucchetti, “Coping strategies in chronic pain,” Current Pain and Headache Reports, vol. 14, no. 5, pp. 331–338, 2010. View at Publisher · View at Google Scholar · View at Scopus
  39. M. J. L. Sullivan, M. E. Lynch, and A. J. Clark, “Dimensions of catastrophic thinking associated with pain experience and disability in patients with neuropathic pain conditions,” Pain, vol. 113, no. 3, pp. 310–315, 2005. View at Publisher · View at Google Scholar · View at Scopus
  40. K. Meyer, A. Tschopp, H. Sprott, and A. F. Mannion, “Association between catastrophizing and self-rated pain and disability in patients with chronic low back pain,” Journal of Rehabilitation Medicine, vol. 41, no. 8, pp. 620–625, 2009. View at Publisher · View at Google Scholar · View at Scopus
  41. D. M. Ehde, T. M. Dillworth, and J. A. Turner, “Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research.,” American Psychologist, vol. 69, no. 2, pp. 153–166, 2014. View at Publisher · View at Google Scholar
  42. D. McLeod and K. Nelson, “The role of the emergency department in the acute management of chronic or recurrent pain,” Australasian Emergency Nursing Journal, vol. 16, no. 1, pp. 30–36, 2013. View at Publisher · View at Google Scholar
  43. M. D. Cheatle, “Depression, chronic pain, and suicide by overdose: On the edge,” Pain Medicine, vol. 12, no. 2, pp. S43–S48, 2011. View at Publisher · View at Google Scholar · View at Scopus
  44. B. Löwe, R. L. Spitzer, K. Gräfe et al., “Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians' diagnoses,” Journal of Affective Disorders, vol. 78, no. 2, pp. 131–140, 2004. View at Publisher · View at Google Scholar · View at Scopus
  45. A. Mailis-Gagnon, B. Yegneswaran, S. F. Lakha et al., “Pain characteristics and demographics of patients attending a university-affiliated pain clinic in Toronto, Ontario,” Pain Research and Management, vol. 12, no. 2, pp. 93–99, 2007. View at Publisher · View at Google Scholar · View at Scopus
  46. R. J. Gatchel, “Psychological disorders and chronic pain: cause and effect relationships,” in Psychological Approaches to Pain Management: A Practitioner's Handbook, R. J. Gatchel and D. C. Turk, Eds., pp. 33–54, Guilford Publications, New York, NY, USA, 1996. View at Google Scholar
  47. A. D. Holzberg, M. E. Robinson, M. E. Geisser, and H. A. Gremillion, “The effects of depression and chronic pain on psychosocial and physical functioning,” Clinical Journal of Pain, vol. 12, no. 2, pp. 118–125, 1996. View at Publisher · View at Google Scholar · View at Scopus
  48. W. J. Dixon and K. A. Fry, “Pain recidivists in the emergency department,” Journal of Emergency Nursing, vol. 37, no. 4, pp. 350–356, 2011. View at Publisher · View at Google Scholar
  49. C. C. Upshur, R. S. Luckmann, and J. A. Savageau, “Primary care provider concerns about management of chronic pain in community clinic populations,” Journal of General Internal Medicine, vol. 21, no. 6, pp. 652–655, 2006. View at Publisher · View at Google Scholar · View at Scopus
  50. M. Johnson, B. Collett, and J. M. Castro-Lopes, “The challenges of pain management in primary care: a pan-European survey,” Journal of Pain Research, vol. 6, pp. 393–401, 2013. View at Publisher · View at Google Scholar · View at Scopus
  51. J. Watt-Watson, M. McGillion, J. Hunter et al., “A survey of prelicensure pain curricula in health science faculties in Canadian universities,” Pain Research and Management, vol. 14, no. 6, pp. 439–444, 2009. View at Publisher · View at Google Scholar · View at Scopus
  52. J. E. O'Rorke, I. Chen, I. Genao, M. Panda, and S. Cykert, “Physicians' comfort in caring for patients with chronic nonmalignant pain,” American Journal of the Medical Sciences, vol. 333, no. 2, pp. 93–100, 2007. View at Publisher · View at Google Scholar · View at Scopus
  53. A. Silversides, “Opioid prescribing challenges doctors,” Canadian Medical Association Journal, vol. 181, no. 8, pp. E143–E144, 2009. View at Publisher · View at Google Scholar · View at Scopus
  54. P. Peng, M. Choiniere, D. Dion et al., “Challenges in accessing multidisciplinary pain treatment facilities in Canada,” Canadian Journal of Anesthesia, vol. 54, no. 12, pp. 977–984, 2007. View at Publisher · View at Google Scholar · View at Scopus
  55. J. D. Loeser, Task Force on Guidelines for Desirable Characteristics for Pain Treatment Facilities, IASP Press, Seattle, Wash, USA, 1990.
  56. A. Minerbi and S. Vulfsons, “Pain medicine in crisis—a possible model toward a solution: empowering community medicine to treat chronic pain,” Rambam Maimonides Medical Journal, vol. 4, no. 4, pp. 1–9, 2013. View at Publisher · View at Google Scholar
  57. S. Tremblay, J. Nelli, P. Poulin et al., Understanding the Burden of Visits for Chronic Pain to The Ottawa Hospital Emergency Department, Annual Gary Johnson Anesthesiology Research Day, Ottawa, Canada, 2014.
  58. D. E. Hoffmann and A. J. Tarzian, “The girl who cried pain: a bias against women in the treatment of pain,” Journal of Law, Medicine & Ethics, vol. 29, no. 1, pp. 13–27, 2001. View at Google Scholar · View at Scopus
  59. R. R. Edwards, M. Moric, B. Husfeldt, A. Buvanendran, and O. Ivankovich, “Ethnic similarities and differences in the chronic pain experience: a comparison of African American, Hispanic, and white patients,” Pain Medicine, vol. 6, no. 1, pp. 88–98, 2005. View at Publisher · View at Google Scholar · View at Scopus