Pain and the Emergency Department

What have you learned about the management of pain in the ED, and what pain patients might be at higher risk for poor care?

How are patients with chronic pain disorders treated in the Emergency Department?

Read through the first roundtable of a two part series with 4 experts in the field of pain treatment. Part one deals with experts discussing some of their thoughts on the quality of care pain patients recieve in the Emergency Department.

Jim Broatch, MSW:

Jim Broatch, MSW, is the Executive Director of the Reflex Sympathetic Dystrophy Association in Milford, CT (www.rsds.org)

Usually I hear about CRPS patients and their experiences in the Emergency Department from their anecdotal reports when they contact us. I hear a lot of “horror stories”. The common elements are that patients wait a long time to be seen, then are given a “dressing down” for having come to the ED, and are “sent packing” without treatment. Together with Johns Hopkins University we posted a questionnaire on our website about patient experiences in the Emergency Department. There were 1,362 responses to the questionnaire and 44% reported a negative experience.

With our patients we have the situation of a disease that is a rare syndrome which most physicians still have still not heard about or understand. Our organization was founded in 1984 by the mothers of two children who had developed CRPS as a result of childhood injuries. A major goal of our organization is to develop better awareness of the problem of CRPS. Not long ago one of our patients traveled to a large hospital to be seen by a specialist in CRPS. While an inpatient there he felt “manhandled” by the medical team. Upon his return he asked our scientific advisory committee to develop a fact sheet about reflex sympathetic dystrophy that could be given to hospital personnel when a patient with CRPS is admitted to the hospital. We are now thinking of developing a similar document for use in Emergency Departments.

The document we developed is titled “Hospital Protocol for the CRPS Patient: Handle With Care!” The first paragraph reads “Reflex Sympathetic Dystrophy (RSD) also known as Complex Regional Pain Syndrome (CRPS) is a chronic condition characterized by severe burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling and extreme sensitivity to touch. People afflicted with CRPS are extraordinarily sensitive to certain stimuli, such as touch, movement, and injections.” The document goes on to list over two dozen specific suggestions for a care plan in areas including: setting up the patient room; performing medical procedures; taking blood pressure and pulse rate; transporting; feeding; and identifying CRPS patients.