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Pain Research and Management
Volume 2018 (2018), Article ID 1875967, 10 pages
https://doi.org/10.1155/2018/1875967
Research Article

Chronic Pain in the Emergency Department: A Pilot Interdisciplinary Program Demonstrates Improvements in Disability, Psychosocial Function, and Healthcare Utilization

1Department of Psychology, Memorial University of Newfoundland, St. John’s, NL, Canada
2The Ottawa Hospital Research Institute, Ottawa, ON, Canada
3School of Psychology & Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada
4The Ottawa Hospital Department of Psychology, Ottawa, ON, Canada
5Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
6School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
7Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

Correspondence should be addressed to Patricia A. Poulin

Received 5 June 2017; Revised 6 September 2017; Accepted 25 October 2017; Published 17 January 2018

Academic Editor: Emily J. Bartley

Copyright © 2018 Joshua A. Rash 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. J. M. Juran and F. M. Gryna, Juran’s Quality Control Handbook, McGraw-Hill, New York, NY, USA, 1988.
  2. E. LaCalle and E. Rabin, “Frequent users of emergency departments: the myths, the data, and the policy implications,” Annals of Emergency Medicine, vol. 56, no. 1, pp. 42–48, 2010. View at Publisher · View at Google Scholar · View at Scopus
  3. B. T. B. Chan and H. J. Ovens, “Frequent users of emergency departments. Do they also use family physicians’ services?” Canadian Family Physician Medecin de Famille Canadien, vol. 48, pp. 1654–1660, 2002. View at Google Scholar
  4. K. H. Todd, P. Cowan, N. Kelly, and P. Homel, “Chronic or recurrent pain in the emergency department: national telephone survey of patient experience,” Western Journal of Emergency Medicine, vol. 11, no. 5, pp. 408–415, 2010. View at Google Scholar
  5. P. Milbrett and M. Halm, “Characteristics and predictors of frequent utilization of emergency services,” Journal of Emergency Nursing, vol. 35, no. 3, pp. 191–198, 2009. View at Publisher · View at Google Scholar · View at Scopus
  6. Y. Shergill, M. Caluyong, S. Tremblay et al., “Understanding the burden of chronic pain at The Ottawa Hospital Emergency Department,” Ottawa, ON, Canada, October 2013.
  7. 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
  8. J. Woodhouse, M. Peterson, C. Campbell, and K. Gathercoal, “The efficacy of a brief behavioral health intervention for managing high utilization of ED services by chronic pain patients,” Journal of Emergency Nursing, vol. 36, no. 5, pp. 399–403, 2010. View at Publisher · View at Google Scholar · View at Scopus
  9. Pain TFoTotIAftSo, Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms, IASP Press, Seattle, WA, USA, 1986.
  10. Mayday Fund, “A call to revolutionize chronic pain care in America: An opportunity in health care reform,” Washington, DC, 2009. View at Google Scholar
  11. B. L. Wilsey, S. M. Fishman, C. Ogden, A. Tsodikov, and K. D. Bertakis, “Chronic pain management in the emergency department: a survey of attitudes and beliefs,” Pain Medicine, vol. 9, no. 8, pp. 1073–1080, 2008. View at Publisher · View at Google Scholar · View at Scopus
  12. 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
  13. J. E. Svenson and T. D. Meyer, “Effectiveness of nonnarcotic protocol for the treatment of acute exacerbations of chronic nonmalignant pain,” American Journal of Emergency Medicine, vol. 25, no. 4, pp. 445–449, 2007. View at Publisher · View at Google Scholar · View at Scopus
  14. D. J. Jorgensen, “Fiscal analysis of emergency admissions for chronic back pain: a pilot study from a Maine hospital,” Pain Medicine, vol. 8, no. 4, pp. 354–358, 2007. View at Publisher · View at Google Scholar · View at Scopus
  15. A. Gawande, The Hot Spotters, The New Yorker, New York, NY, USA, 2011.
  16. N. R. Hoot and D. Aronsky, “Systematic review of emergency department crowding: causes, effects, and solutions,” Annals of Emergency Medicine, vol. 52, no. 2, pp. 126–136, 2008. View at Publisher · View at Google Scholar · View at Scopus
  17. Institute of Medicine, “IOM report: the future of emergency care in the United States health system,” Academic Emergency Medicine, vol. 13, no. 10, pp. 1081–1085, 2006. View at Publisher · View at Google Scholar · View at Scopus
  18. R. W. Derlet, D. Kinser, L. Ray, B. Hamilton, and J. McKenzie, “Prospective identification and triage of nonemergency patients out of an emergency department: a 5-year study,” Annals of Emergency Medicine, vol. 25, no. 2, pp. 215–223, 1995. View at Publisher · View at Google Scholar · View at Scopus
  19. A. C. Durand, S. Palazzolo, N. Tanti-Hardouin, P. Gerbeaux, R. Sambuc, and S. Gentile, “Nonurgent patients in emergency departments: rational or irresponsible consumers? Perceptions of professionals and patients,” BMC Research Notes, vol. 5, no. 1, p. 525, 2012. View at Publisher · View at Google Scholar · View at Scopus
  20. 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 · View at Scopus
  21. J. B. Braden, J. Russo, M. Y. Fan et al., “Emergency department visits among recipients of chronic opioid therapy,” Archives of Internal Medicine, vol. 170, no. 16, pp. 1425–1432, 2010. View at Publisher · View at Google Scholar · View at Scopus
  22. I. A. Dhalla, M. M. Mamdani, M. L. 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
  23. A. Kolodny, D. T. Courtwright, C. S. Hwang et al., “The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction,” Annual Review of Public Health, vol. 36, no. 1, pp. 559–574, 2015. View at Publisher · View at Google Scholar · View at Scopus
  24. F. Althaus, S. Paroz, O. Hugli et al., “Effectiveness of interventions targeting frequent users of emergency departments: a systematic review,” Annals of Emergency Medicine, vol. 58, no. 1, pp. 41–52 e42, 2011. View at Publisher · View at Google Scholar · View at Scopus
  25. G. S. Kumar and R. Klein, “Effectiveness of case management strategies in reducing emergency department visits in frequent user patient populations: a systematic review,” Journal of Emergency Medicine, vol. 44, no. 3, pp. 717–729, 2013. View at Publisher · View at Google Scholar · View at Scopus
  26. J. Moe, S. W. Kirkland, E. Rawe et al., “Effectiveness of interventions to decrease emergency department visits by adult frequent users: a systematic review,” Academic Emergency Medicine, vol. 24, no. 1, pp. 40–52, 2017. View at Publisher · View at Google Scholar
  27. L. J. Soril, L. E. Leggett, D. L. Lorenzetti, T. W. Noseworthy, and F. M. Clement, “Reducing frequent visits to the emergency department: a systematic review of interventions,” PLoS One, vol. 10, no. 4, p. e0123660, 2015. View at Publisher · View at Google Scholar · View at Scopus
  28. S. Oslund, R. C. Robinson, T. C. Clark et al., “Long-term effectiveness of a comprehensive pain management program: strengthening the case for interdisciplinary care,” Proceedings-Baylor University Medical Center, vol. 22, no. 3, pp. 211–214, 2009. View at Google Scholar
  29. L. Scascighini, V. Toma, S. Dober-Spielmann, and H. Sprott, “Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes,” Rheumatology, vol. 47, no. 5, pp. 670–678, 2008. View at Publisher · View at Google Scholar · View at Scopus
  30. S. S. Weiner and M. Nordin, “Prevention and management of chronic back pain,” Best Practice and Research Clinical Rheumatology, vol. 24, no. 2, pp. 267–279, 2010. View at Publisher · View at Google Scholar · View at Scopus
  31. R. J. Gatchel, D. D. McGeary, C. A. McGeary, and B. Lippe, “Interdisciplinary chronic pain management: past, present, and future,” American Psychologist, vol. 69, no. 2, pp. 119–130, 2014. View at Publisher · View at Google Scholar · View at Scopus
  32. R. Chou, J. D. Loeser, D. K. Owens et al., “Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society,” Spine, vol. 34, no. 10, pp. 1066–1077, 2009. View at Publisher · View at Google Scholar · View at Scopus
  33. R. N. Harden, A. L. Oaklander, A. W. Burton et al., “Complex regional pain syndrome: practical diagnostic and treatment guidelines,” Pain Medicine, vol. 14, no. 2, pp. 180–229, 2013. View at Publisher · View at Google Scholar · View at Scopus
  34. R. H. Dworkin, D. C. Turk, J. T. Farrar et al., “Core outcome measures for chronic pain clinical trials: IMMPACT recommendations,” Pain, vol. 113, no. 1-2, pp. 9–19, 2005. View at Publisher · View at Google Scholar · View at Scopus
  35. C. S. Cleeland and K. M. Ryan, “Pain assessment: global use of the Brief Pain Inventory,” Annals of the Academy of Medicine, vol. 23, no. 2, pp. 129–138, 1994. View at Google Scholar
  36. H. Kapstad, B. Rokne, and K. Stavem, “Psychometric properties of the Brief Pain Inventory among patients with osteoarthritis undergoing total hip replacement surgery,” Health and Quality of Life Outcomes, vol. 8, no. 1, p. 148, 2010. View at Publisher · View at Google Scholar · View at Scopus
  37. S. Keller, C. M. Bann, S. L. Dodd, J. Schein, T. R. Mendoza, and C. S. Cleeland, “Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain,” Clinical Journal of Pain, vol. 20, no. 5, pp. 309–318, 2004. View at Publisher · View at Google Scholar · View at Scopus
  38. T. Mendoza, T. Mayne, D. Rublee, and C. Cleeland, “Reliability and validity of a modified Brief Pain Inventory short form in patients with osteoarthritis,” European Journal of Pain, vol. 10, no. 4, pp. 353–361, 2006. View at Publisher · View at Google Scholar · View at Scopus
  39. 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
  40. C. Cleeland, The Brief Pain Inventory: User guide, University of Texas, M. D. Anderson Cancer Center, Houston, TX, USA, 2009.
  41. R. H. Dworkin, D. C. Turk, K. W. Wyrwich et al., “Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations,” Journal of Pain, vol. 9, no. 2, pp. 105–121, 2008. View at Publisher · View at Google Scholar · View at Scopus
  42. 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
  43. K. Kroenke, R. L. Spitzer, J. B. Williams, and B. Lowe, “The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review,” General Hospital Psychiatry, vol. 32, no. 4, pp. 345–359, 2010. View at Publisher · View at Google Scholar · View at Scopus
  44. R. L. Spitzer, K. Kroenke, J. B. Williams, and B. Lowe, “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
  45. 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
  46. A. Osman, F. X. Barrios, B. A. Kopper, W. Hauptmann, J. Jones, and E. O’Neill, “Factor structure, reliability, and validity of the Pain Catastrophizing Scale,” Journal of Behavioral Medicine, vol. 20, no. 6, pp. 589–605, 1997. View at Google Scholar
  47. A. Osman, F. X. Barrios, P. M. Gutierrez, B. A. Kopper, T. Merrifield, and L. Grittmann, “The Pain Catastrophizing Scale: further psychometric evaluation with adult samples,” Journal of Behavioral Medicine, vol. 23, no. 4, pp. 351–365, 2000. View at Google Scholar
  48. C. H. Bastien, A. Vallieres, 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
  49. C. M. Morin and D. H. Barlow, Insomnia: Psychological Assessment and Management, Guilford Press, New York, NY, USA, 1993.
  50. C. Gagnon, L. Belanger, H. Ivers, and C. M. Morin, “Validation of the Insomnia Severity Index in primary care,” Journal of the American Board of Family Medicine, vol. 26, no. 6, pp. 701–710, 2013. View at Publisher · View at Google Scholar · View at Scopus
  51. C. M. Morin, G. Belleville, L. Belanger, and H. Ivers, “The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response,” Sleep, vol. 34, no. 5, pp. 601–608, 2011. View at Publisher · View at Google Scholar
  52. M. H. Savard, J. Savard, S. Simard, and H. Ivers, “Empirical validation of the Insomnia Severity Index in cancer patients,” Psycho-Oncology, vol. 14, no. 6, pp. 429–441, 2005. View at Publisher · View at Google Scholar · View at Scopus
  53. 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
  54. M. Herdman, C. Gudex, A. Lloyd et al., “Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L),” Quality of Life Research, vol. 20, no. 10, pp. 1727–1736, 2011. View at Publisher · View at Google Scholar · View at Scopus
  55. The EuroQol Group, “EuroQol–a new facility for the measurement of health-related quality of life,” Health Policy, vol. 16, no. 3, pp. 199–208, 1990. View at Publisher · View at Google Scholar · View at Scopus
  56. B. van Hout, M. F. Janssen, Y. S. Feng et al., “Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets,” Value in Health, vol. 15, no. 5, pp. 708–715, 2012. View at Publisher · View at Google Scholar · View at Scopus
  57. H. Hurst and J. Bolton, “Assessing the clinical significance of change scores recorded on subjective outcome measures,” Journal of Manipulative and Physiological Therapeutics, vol. 27, no. 1, pp. 26–35, 2004. View at Publisher · View at Google Scholar · View at Scopus
  58. P. R. Dunkl, A. G. Taylor, G. G. McConnell, A. P. Alfano, and M. R. Conaway, “Responsiveness of fibromyalgia clinical trial outcome measures,” Journal of Rheumatology, vol. 27, no. 11, pp. 2683–2691, 2000. View at Google Scholar
  59. J. T. Farrar, J. P. Young Jr., L. LaMoreaux, J. L. Werth, and R. M. Poole, “Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale,” Pain, vol. 94, no. 2, pp. 149–158, 2001. View at Publisher · View at Google Scholar · View at Scopus
  60. B. G. Tabachnick and L. S. Fidell, Using Multivariate Statistics, Pearson, New York, NY, USA, 2013.
  61. R. J. A. Little and D. B. Rubin, Statistical Analysis With Missing Data, John Wiley & Sons, Hoboken, NJ, USA, 2002.
  62. S. B. Morris and R. P. DeShon, “Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs,” Psychological Methods, vol. 7, no. 1, pp. 105–125, 2002. View at Publisher · View at Google Scholar · View at Scopus
  63. C. J. Ferguson, “An effect size primer: a guide for clinicians and researchers,” Professional Psychology: Research and Practice, vol. 40, no. 5, pp. 532–538, 2009. View at Publisher · View at Google Scholar · View at Scopus
  64. C. J. Ferguson, “Is psychological research really as good as medical research? Effect size comparisons between psychology and medicine,” Review of General Psychology, vol. 13, no. 2, pp. 130–136, 2009. View at Publisher · View at Google Scholar · View at Scopus
  65. S. M. Murphy and D. Neven, “Cost-effective: emergency department care coordination with a regional hospital information system,” Journal of Emergency Medicine, vol. 47, no. 2, pp. 223–231, 2014. View at Publisher · View at Google Scholar · View at Scopus
  66. S. Stokes-Buzzelli, J. M. Peltzer-Jones, G. B. Martin, M. M. Ford, and A. Weise, “Use of health information technology to manage frequently presenting emergency department patients,” Western Journal of Emergency Medicine, vol. 11, no. 4, pp. 348–353, 2010. View at Google Scholar
  67. D. McMillan, S. Gilbody, and D. Richards, “Defining successful treatment outcome in depression using the PHQ-9: a comparison of methods,” Journal of Affective Disorders, vol. 127, no. 1–3, pp. 122–129, 2010. View at Publisher · View at Google Scholar · View at Scopus
  68. F. Benedetti, W. Thoen, C. Blanchard, S. Vighetti, and C. Arduino, “Pain as a reward: changing the meaning of pain from negative to positive co-activates opioid and cannabinoid systems,” Pain, vol. 154, no. 3, pp. 361–367, 2013. View at Publisher · View at Google Scholar · View at Scopus
  69. M. P. Jensen, J. A. Turner, J. M. Romano, and B. K. Lawler, “Relationship of pain-specific beliefs to chronic pain adjustment,” Pain, vol. 57, no. 3, pp. 301–309, 1994. View at Publisher · View at Google Scholar · View at Scopus
  70. L. J. Paulozzi, C. M. Jones, K. A. Mack, and R. Rudd, “Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008,” Morbidity and Mortality Weekly Report, vol. 60, no. 43, pp. 1487–1492, 2011. View at Google Scholar
  71. Office of Chief Coroner of Ontario, Toronto, ON, Canada, Report from 2009–2011, 2013, http://www.mcscs.jus.gov.on.ca/sites/default/files/content/mcscs/docs/ec161620.pdf.
  72. N. D. Volkow, T. A. McLellan, J. H. Cotto, M. Karithanom, and S. R. Weiss, “Characteristics of opioid prescriptions in 2009,” JAMA, vol. 305, no. 13, pp. 1299–1301, 2011. View at Publisher · View at Google Scholar · View at Scopus
  73. M. Mazer-Amirshahi, P. M. Mullins, I. Rasooly, J. van den Anker, and J. M. Pines, “Rising opioid prescribing in adult U.S. emergency department visits: 2001–2010,” Academic Emergency Medicine, vol. 21, no. 3, pp. 236–243, 2014. View at Publisher · View at Google Scholar · View at Scopus
  74. W. B. Millard, “Grounding frequent flyers, not abandoning them: drug seekers in the ED,” Annals of Emergency Medicine, vol. 49, no. 4, pp. 481–486, 2007. View at Publisher · View at Google Scholar
  75. 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
  76. 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
  77. R. J. Gatchel, “Comorbidity of chronic pain and mental health disorders: the biopsychosocial perspective,” American Psychologist, vol. 59, no. 8, pp. 795–805, 2004. View at Publisher · View at Google Scholar · View at Scopus
  78. J. H. Mandelberg, R. E. Kuhn, and M. A. Kohn, “Epidemiologic analysis of an urban, public emergency department’s frequent users,” Academic Emergency Medicine, vol. 7, no. 6, pp. 637–646, 2000. View at Publisher · View at Google Scholar
  79. A. Hackshaw, “Small studies: strengths and limitations,” European Respiratory Journal, vol. 32, no. 5, pp. 1141–1143, 2008. View at Publisher · View at Google Scholar · View at Scopus