Background & Aims
Pain is one of the most common reasons for presenting to the Emergency Department (ED) in the United States (US).1,2 There are limited studies exploring patient perceptions and expectation of ED pain management. The few existing studies were narrow in scope, focusing on the current ED visit, and conducted in non-US populations treated in healthcare systems different from that of the US.3 Additionally, patient knowledge regarding the opioid epidemic and state related legislative changes in the US are not well documented. Existing literature lacks viewpoints from socioeconomically disadvantaged and minority US patient populations who historically tend to receive inadequate pain control in the ED.4 More research is needed to characterize patient perceptions, expectations and motivations when seeking pain relief in the ED, particularly disadvantaged patient populations. Additionally, assessing knowledge of laws related to ED pain care may identify opportunities to address goals of care.
Methods
A survey assessing patients’ perceptions and expectations of emergency pain management and knowledge of opioid prescribing laws was developed based on relevant literature and clinical experiences of emergency physicians on the study team. Surveys were administered to a convenience sample of adult patients seeking care in the ED of a large, urban, academic hospital system from May 2023 to January 2024. Non-incarcerated, English-speaking adults who were able to provide consent and had at least one ED visit for pain were eligible to participate. Regressions were performed in Excel 2019 to identify associations between survey responses and sociodemographic variables (including marital status, area deprivation index (ADI), highest education and medical insurance type) and history of chronic pain (yes/no). This study was approved by the sponsoring university’s Institutional Review Board.
Results
The survey was completed by 109 participants. Mean age was 52 years. The majority identified as female (64%), black (60%), and lived in disadvantaged neighborhoods (mean ADI 83). Many felt ED pain care differed from other healthcare settings (42%); pain was addressed in a timely (75%) and adequate manner (85%); ED providers cared about their pain (80%); and clinician communication could reduce pain (51%). Half (50%) expected to receive non-pharmacologic options, 55% did not expect to receive opioids and 36% expected complete pain resolution. Many were aware of the opioid epidemic (63%) and laws limiting opioid prescribing (51%) but were unaware of laws supporting opioid alternatives (47%). Most (66%) under/uninsured and none of the privately insured expected opioid treatment (p<0.01). Most (66%) under/uninsured and none of the privately insured were aware of opioid alternative laws (p<0.01). No other significant associations were identified.
Conclusions
In a high minority and disadvantaged patient population, there was a preference to receive pain care in the ED compared to other healthcare settings, potentially due to a perceived sense of expedient treatment from providers who cared about them. There was also a relatively high and low expectation for nonpharmacologic and opioid treatment, respectively, in the ED possibly due to patients’ awareness of the ongoing opioid epidemic. There was a concerningly high proportion of patients who expected complete pain resolution from their ED care but also reassuring to note that many felt communication with their ED providers could help alleviate their pain. Insurance coverage (potential surrogate marker of (in)adequate healthcare access) may play a role in patient expectations regarding ED opioid treatment. Understanding patient motivations and expectations when seeking pain care in the ED may help ED clinicians provide better care for the millions of patients presenting to the ED for pain.
References
1.Cordell WH, Keene KK, Giles BK, Jones JB, Jones JH, Brizendine EJ. The high prevalence of pain in emergency medical care. Am J Emerg Med. 2002;20(3):165-169. doi:10.1053/ajem.2002.32643
2.Tanabe P, Buschmann M. A prospective study of ED pain management practices and the patient’s perspective. J Emerg Nurs. 1999;25(3):171-177. doi:10.1016/s0099-1767(99)70200-x
3.Hamalainen, J.,M.ScN.R.N., Kvist, T.,Professor PhD.R.N., & Kankkunen, P.,PhD.R.N. (2021). Exploratory study of patient perceptions of pain management in emergency department. International Journal of Caring Sciences, 14(3), 1547-1557. Retrieved from https://login.lp.hscl.ufl.edu/login?url=https://www.proquest.com/scholarly-journals/exploratory-study-patient-perceptions-pain/docview/2630948428/se-2
4.Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016 Apr 19;113(16):4296-301. doi: 10.1073/pnas.1516047113. Epub 2016 Apr 4. PMID: 27044069; PMCID: PMC4843483.
Presenting Author
Sophia Sheikh
Poster Authors
Sophia Sheikh, MD
MD
University of Florida College of Medicine - Jacksonville
Lead Author
Magda Montague
MPH
University of Florida College of Medicine – Jacksonville
Lead Author
Zackary Funk
MD
University of Florida College of Medicine – Jacksonville
Lead Author
Bhakti Chourasia
MD
University of Florida College of Medicine – Jacksonville
Lead Author
Megan Curtis Gonzalez
University of Florida College of Medicine - Jacksonville
Lead Author
Michelle Lott
BSH
University of Florida College of Medicine – Jacksonville
Lead Author
Taylor Munson
MPH
University of Florida College of Medicine – Jacksonville
Lead Author
Nolan Menze
BSH
University of Florida College of Medicine – Jacksonville
Lead Author
Phyllis Hendry
MD
University of Florida College of Medicine – Jacksonville
Lead Author
Topics
- Racial/Ethnic/Economic Differences/Disparities