Pain continues to be one of the top reasons for patients seeking care at EDs, but little is known about their perspectives and experiences when being treated for pain in this setting. For a qualitative study published in Annals of Emergency Medicine, Zachary F. Meisel, MD, MPH, MS, and colleagues examined important themes surrounding the perspectives and experiences of patients receiving pain treatment in the ED. The authors conducted structured, open-ended telephone interviews with 23 patients who were discharged from the Hospital of the University of Pennsylvania after being seen in the ED during a 4-month period. Most patients were women and between the ages of 18 and 65, and participants were included if they were discharged for pain relating to kidney stones or musculoskeletal injuries.
Study participants discussed a variety of topics relating to their experiences with communication around pain, including views on opioid dependence and addiction as well as patient-provider communication about pain management. “Patients felt that using the typical 1-to-10 pain rating scale was problematic because it limited their interactions with emergency physicians,” says Dr. Meisel. “From the patient perspective, emergency physicians also did not typically discuss alternative pain management options or adequately describe risks of opioid dependence.”
Four overarching themes surrounding patients views on opioid dependence emerged in the study, including:
- Fears of developing dependence or addition.
- Worries about following prescribed dosing to prevent potential addiction.
- Relying on media and other individuals as sources of information about opioids rather than on healthcare providers.
- Awareness of the broad tensions that healthcare providers face relating to the prescription of opioid therapy.
In addition, patients with negative experiences relating to their pain management reported having problems communicating with their provider that led to a misunderstanding of their clinical diagnosis. “These patients also described fragmentation of care among their providers and expressed a desire to be involved in the decision-making process around their pain management,” Dr. Meisel says. Patients with positive experiences reported having more regular communication with their care team, having their pain managed rapidly, and having healthcare providers who were empathetic in nature.
According to Dr. Meisel, there is a clear and significant need for EDs to improve patient education on the risks of opioid misuse. “Patients tend to understand that EDs are busy, but that doesn’t reduce their desire to have meaningful interactions with their providers,” he says. “Patients want to be given information that can help them better understand the causes of their pain and their treatment options. Our findings can be seen as a call to action for ED physicians to discuss pain management more thoroughly with patients. Improving communication is critical to ensuring that patients aren’t denied the option of using opioids if they are good candidates to receive these medications.”
Smith RJ, Rhodes K, Paciotti B, Kelly S, Perrone J, Meisel ZF. Patient perspectives of acute pain management in the era of the opioid epidemic. Ann Emerg Med. 2015;66:246-252 Available at: http://www.annemergmed.com/article/S0196-0644(15)00232-2/abstract.
Kilaru AS, Gadsden SM, Perrone J, Paciotti B, Barg FK, Meisel ZF. How do physicians adopt and apply opioid prescription guidelines in the emergency department? A qualitative study. Ann Emerg Med. 2014;64:482-489.
Conrardy M, Lank P, Cameron KA, et al. Emergency department patient perspectives on the risk of addiction to prescription opioids. Pain Med. 2015 Sep 1 [Epub ahead of print].