Discussion - Chronic Pain

Reassessed patient at this time and discussed recurrent [site] pain issues with [him/her].  This is the [###] time the patient has been evaluated in this Emergency Department for [site] pain in the past [time frame].  I emphasized with the patient that my training is primarily in the treatment of acute pain complaints, that [his/her] exam is reassuring at this time, and that definitive care of chronic pain is not the role of the Emergency Department.

[He/She] also was noted to be demonstrating the following behaviors known to be associated with inappropriate use of pain medications and addiction:

    -inability to restrict medications or take them on an agreed upon schedule

    -taking multiple medications together

    -doctor shopping

    -the use of non-prescribed psychoactive medications in addition to prescribed medications

    -noncompliance with recommended non-opioid medications or evaluations

    -a preoccupation with opioid medications

    -insistence on rapid-onset formulations and routes of administrations

    -reports of allergy or no relief whatsoever from non-opioid treatments

I explained to the patient that I felt that providing opioid medications from the Emergency Department was counterproductive in that this may cause or exacerbate tolerance, acute overdose, physiological or psychological dependence, or withdrawal.  We discussed that opioid use in the management of chronic pain is best managed by a single practitioner, such as a primary care provider or pain specialist.  We discussed adjunctive therapies such as heat, ice, and exercise, as well as non-opioid medications such as Acetaminophen, NSAIDs, antidepressants, lidocaine patches, Gabapentin, and Pregabalin.  We discussed that additional medications for pain management should be discussed with a primary care provider, as some require close monitoring.

I reiterated to [Patient’s Name] that the most effective management of [his/her] chronic pain is a multimodal approach coordinated by [his/her] primary care provider, that may include physical therapy, cognitive behavioral therapy, and referrals to specialists in pain management.

https://www.acep.org/patient-care/smart-phrases/why-narcoticopioid-medications-were-not-prescribed/
https://www.acep.org/patient-care/smart-phrases/emergency-naloxone-programs---information-for-providers/
https://www.acep.org/patient-care/smart-phrases/emergency-naloxone-programs---patient-information/