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Acute Pain Emergency

Approximately 151 million people visit emergency departments (EDs) each year. The most common complaint is abdominal pain, as shown in our cover story by Kimberly Sapre, DMSc, PA-C, CAQ-EM. Health care providers may apply cognitive heuristics, or gut instincts, to make treatment choices in the chaotic environment of the ED. However, Dr Sapre believes that “heavy reliance on cognitive heuristics may lead to unconscious or implicit biases when caring for patients.”

Findings from Dr Sapre’s restrospective review of medical records from 17,401 ED visits at a single institution showed that racial/ethnic minority patients and women often receive fewer pain medications compared with White men. Many researchers have tried to understand the undertreatment of pain in EDs. Because pain can’t be measured objectively, assessments must rely on a subjective numerical pain scale, or visual pain scale, which rates a patient’s pain on a scale of 0 to 10. Often, a patient’s perception of pain does not match the clinician’s assessment of the patient’s pain, leading to inadequate pain management in the ED, as found in previous clinical studies.

Clinicians have gone back and forth over the under- vs overtreatment of acute and chronic pain for decades. To help guide treatment decisions, the Centers for Disease Control and Prevention (CDC) recently released recommendations for prescribing opioid pain medication for acute, subacute, and chronic pain, which update the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain that was released amid the opioid crisis, led in part by the overprescribing of oral opioids in EDs.

“Patients with pain should receive compassionate, safe, and effective pain care,” Christopher M. Jones, PharmD, DrPH, MPH, acting director of the CDC’s National Center for Injury Prevention and Control, said in a press release. “We want clinicians and patients to have the information they need to weigh the benefits of different approaches to pain care, with the goal of helping people reduce their pain and improve their quality of life.”

Being aware of our bias and the appropriate use/amount of opioids and nonopioid medications can help improve acute pain management for all.

Nikki Kean, Director The Clinical Adviso r