Pain Mangement Journals
JLME Volume 33:4, 2005
JLME Volume 31:1, 2003
JLME Volume 29:1, 2001
JLME Volume 26:4, 1998
JLME Volume 24:4, 1996
JLME Volume 33:4, 2005
Read the full articles of this issue here
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Symposium Articles
Introduction
Introduction: Pain Management in the Emergency Department:
Current Landscape and Agenda for Research
Sandra H. Johnson
The Social, Professional, and Legal Framework for the Problem
of Pain Management in Emergency Medicine
Sandra H. Johnson
The ED bears the primary responsibility for treating
trauma patients, and untreated acute pain has been
associated with negative medical outcomes. In addition,
our system also relies on the ED for treatment
of chronic pain and pain at the end of life. While
emergency medicine faces common challenges in
pain management, there are also distinctive conditions
in the ED that impair pain treatment, including
the prioritization of diagnosis; inadequacies in
pain assessment; and a culture that supports
detachment. Areas of liability risk also reveal
systemic issues impairing effective pain management in
the ED.
Chronic Pain and Aberrant Drug-Related Behavior in the Emergency
Department
Knox H. Todd
Emergency physicians commonly evaluate those
with chronic pain and substance abuse disorders;
they are more common among emergency department
patients that in the general population.
Concern regarding coexisting substance use disorders
among patients with pain in.uences treatment;
however, the relationship between these two conditions
is often murky and limited research is available
to guide clinical decision making. At both individual
and population levels, a balanced perspective in
approaching this dif.cult issue will best serve
patients.
Prescription Opioid Abuse in the
Emergency Departments
Barth L. Wilsey, Scott M. Fishman, Christine Ogden
Patients in pain who seek opioids in the Emergency
Department (ED) may appear to be doctor shopping.
But such presentations must never exclusively
be taken as evidence of aberrant behavior in a
patient seeking to obtain opioids in an ED.
Emergency physicians are challenged to reserve
judgment even when presented with a patient who
seems to have drug-seeking behavior, as this impression
may be false. Sometimes, there are no other
providers available and patients must attempt to
find care in the ED as a “last resort.” Since there is
rarely a single behavior or event that con.rms the
diagnosis of addiction in a chronic pain patient, the
diagnosis usually remains elusive in the ED setting.
In order to help ED physicians .nd a more tangible
method for assessing the potential for opioid misuse
in the ED, new screening tools are currently being
developed. In addition, legislative initiatives and
technological advances in the form of prescription
monitoring databases may someday make it feasible
for an ED physician to screen patients for evidence
of multiple providers.
Clinical Guidelines and Policies: Can they Improve Emergency Department Pain Management?
James Ducharme
This article reviews published guidelines and recommendations
related to emergency pain management,
identifying barriers to their implementation. Legal
concerns toward guideline utilization are presented.
Improving the (poor) dissemination of new medical
information is also discussed. Methods successfully
used in improving pain management in other areas
of health care will be reviewed in an effort to
improve pain management in emergency medicine.
