A NEW APPROACH TO CHRONIC PAIN IN THE ED

Patients presenting to emergency departments (EDs) for primary manage ment of chronic or recurrent nonmalignant pain conditions and their ph ysicians frequently report dissatisfaction, in part because of the imp ressions created by a small percentage of such patients that frequentl y visit EDs requesting opioids. Treating such patients with opioids is contrary to many published guidelines, but refusing them increases di ssatisfaction. Narcotic registers serve to label patients who are susp ected of seeking drugs, thus creating anxiety and often distrust in he alth care professionals treating them. The four Calgary adult EDs have developed a system that will attempt to remove labels associated with some of these patients, insure communication between patients, their family doctors, and ED staff, and facilitate optimal care of the patie nts' real problems, be they difficult home management of pain, drug de pendence or addiction, or other social issues. Emphasis will be shifte d to home management and the family doctor's office. If successful, th e system will minimize ED visits by frequent attendees seeking medicat ion for pain control, and should also decrease overall expenditure to the health care system. (Am J Emerg Med 1996;14:323-326. Copyright (C) 1996 by W.B. Saunders Company)