CHRONIC PAIN IN THE EMERGENCY DEPARTMENT: UNDERSTANDING CONTRIBUTING FACTORS TO IMPROVE HEALTH CARE OUTCOMES, HEALTH CARE UTILIZATION AND PRESCRIPTION OPIOID ABUSE



Why was the study done?
A study at The Ottawa Hospital found that 10.4% of all Emergency Department visits were related to chronic pain, and of those visits, 36.5% were patients suffering from chronic pain. The purpose of this study is to determine the proportion of patients with chronic pain who are frequent users of the Emergency Department, who have had access to self-management, inter-disciplinary interventions or to a pain specialist; ascertain stakeholders’ expectations of how chronic pain should be managed in the Emergency Department; and explore the different reasons for presentation, care provided, care expectations and access to self-management, interdisciplinary program or pain specialists. 

 

How was the study done?
The initial phase of the project was completed through a series of chart reviews and administration of a comprehensive patient questionnaire to a sample from academic pain clinics across Canada. Interviews were also conducted with patients and primary care providers. 

 

What were the study results?
Our team reviewed 988 consecutive patient admissions and found evidence of chronic pain documented in 13% of admissions and evidence of substance use problems documented in 12% of admissions. One in five patients with chronic pain in the Emergency Department also had documentation of problematic substance use. Those with chronic pain or substance use problem had substantially longer admissions than those without. There was very little evidence of any attention being given to substance use or chronic pain during these admissions. Our team continues to evaluate the effects of mindfulness-based interventions for people living with chronic neuropathic pain. We are about to complete data collection for a 3-year randomized controlled trial involving 77 participants with chronic neuropathic pain who have completed an online mindfulness-based intervention aimed at improving pain, quality of life, and mental health. The results of this study will allow us to determine if an 8-week mindfulness-based pain management course in addition to medical treatment optimization will have an improved pain and mental health measures as compared to a wait-list control group.



Recent Updates:
Completed 18 interviews with people who live with chronic neuropathic pain and completed an 8-week online mindfulness-based pain management intervention, including techniques and skills learned and applied; barriers to practice; and research experiences.
Last updated: January 2021


Selected Publications:
  • Glynn, B., Khoo, E.L., MacLeay, H.M.L., Cantave, R., & Poulin, P. (2020). Exploring Cancer Patients’ Experiences of an online Mindfulness-Based Program: A qualitative Investigation. Mindfulness. In Press.
  • Shergill Y, Rice D, Smyth C, Tremblay S, Nelli J, Small R, Hebert G, Singer L, Rash J.A., Poulin P.A. (2020). Characteristics of frequent users of the emergency department with chronic pain. Canadian Journal of Emergency Medicine. 1-9. DOI 10.1017/cem.2019.464
  • Small, R., Tremblay, S., Nelli, J., Shergill, Y., Smyth, C, Rice, D., & Poulin, P. A. (2019). Understanding the impact of chronic pain in the emergency department: Prevalence and characteristics of patients visiting the emergency department for chronic pain at an urban academic health sciences centre. Canadian Journal of Pain. 3(1).
  • Glynn, B., Brulé, M., Kenny, S., Khoo, E.-L., Shergill, Y., Smyth, C., & Poulin, P. A. (2019). Understanding high frequency use of the emergency department for chronic pain patients: A mixed-method study. Journal for Healthcare Quality. 41(4):195-211.