Prevalence and treatment of pain in EDs in the United States, 2000 to 2010

• Published in: The American journal of emergency medicine 2014-05, Vol.32 (5), p.421-431
• Main Authors: Chang, Hsien-Yen, PhD, Daubresse, Matthew, MHS, Kruszewski, Stefan P., MD, Alexander, G. Caleb, MD, MS
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Ambulatory care; Analgesics; Analgesics - therapeutic use; Cross-Sectional Studies; Emergency; Emergency medical care; Emergency Service, Hospital; Female; Hospitals; Humans; Male; Mental disorders; Middle Aged; Mortality; Pain; Pain - epidemiology; Pain - prevention & control; Pain management; Pain Management - methods; Pain Measurement; Practice Patterns, Physicians' - statistics & numerical data; Prevalence; Substance abuse treatment; United States - epidemiology
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2014.01.015

Abstract Objectives To describe changes in the prevalence and severity of pain and prescribing of non-opioid analgesics in US emergency departments (EDs) from 2000 to 2010. Methods Analysis of serial cross-sectional data regarding ED visits from the National Hospital Ambulatory Medical Care Survey. Visits were limited to patients ≥ 18 years old without malignancy. Outcome measures included annual volume of visits among adults with a primary symptom or diagnosis of pain, annual rates of patient-reported pain severity, and predictors of non-opioid receipt for non-malignant pain. Results Rates of pain remained stable, representing approximately 45% of visits from 2000 through 2010. Patients reported pain as their primary symptom twice as often as providers reported a primary pain diagnosis (40% vs 20%). The percentage of patients reporting severe pain increased from 25% (95% confidence intervals [CI] 22%-27%) in 2003 to 40% (CI 37%-42%) in 2008. From 2000 to 2010, the proportion of pain visits treated with pharmacotherapies increased from 56% (CI 53%-58%) to 71% (CI 69%-72%), although visits treated exclusively with non-opioids decreased 21% from 28% (CI 27%-30%) to 22% (CI 20%-23%). The adjusted odds of non-opioid rather than opioid receipt were greater among visits for patients 18 to 24 years old (odds ratio [OR] 1.35, CI 1.24-1.46), receiving fewer medicines (OR 2.91, CI 2.70-3.15) and those with a diagnosis of mental illness (OR 2.24, CI 1.99-2.52). Conclusions Large increases in opioid utilization in EDs have coincided with reductions in the use of non-opioid analgesics and an unchanging prevalence of pain among patients.