Article Summary and Critique

Chronic Pain and Utilization of Emergency Services

Tracy Brown

University of Mary Washington






Chronic Pain and Utilization of Emergency Services

The purpose of the Emergency Department (ED) is to provide emergent services. Its primary function is to evaluate, treat, and manage acute care for patients within the community. There has been controversial debate whether evidence supports effective management of chronic pain in adult’s patients seeking care in the emergency department. This issue is largely due to the fact that chronic pain is a condition that requires specialized long term management that cannot be provided in an acute care setting. In an article entitled “Chronic pain management in the emergency department: a survey of attitudes and beliefs”, the author states “the prominent reason for using ED services for many chronic pain issues is the absence of alternate healthcare (Wilsey, Fishman, Ogden, Tsodikov, & Bertakis, 2008, p. 1073). Chronic pain patients are forced to obtain care through the emergency department due to reasons such as lack of insurance, inadequate income, and medication abuse. The uninsured are less likely to seek follow up care for chronic conditions (Mason, Leavitt, & Chaffee, 2014, p. 192). These reasons cause chronic pain patients to misuse resources such as the ED. This results in patients needing to return to the ED more frequently for pain management and does not address the need for long term management of these chronic pain patients. Providing care for patients with chronic pain problems in the emergency department also causes multiple issues of overcrowding, longer wait times, patient dissatisfaction, and loss in revenue.

In an article entitled “Characteristics and Predictors of Frequent Utilization of Emergency Services”, the authors explored the characteristics of frequent ED users and the factors predictive of the high utilization. The authors state “although frequent ED users account for a small percentage of ED visits, these patients can drain the system, contributing to overcrowding and lowering quality of care” (Milbrett & Halm, 2009, p. 191). This research study conducted at a large Midwestern urban hospital examined adult patients with a minimum of six ED visits between the years of 2005-2006. They found that most frequent users were commonly female, 35 years old, white, single, unemployed, living alone, with private insurance/Medicaid and had access to a primary care physician (Milbrett & Halm, 2009, p. 191). The top chief complaints were abdominal pain, headache, chest pain, low back pain, and lower extremity pain, with pain being the overall top chief complaint (Milbrett & Halm, 2009, p. 191). They further discuss the many factors that were predictive of greater use of emergency services such as acute exacerbation of a chronic condition. The results of this study found that, “although frequent ED users represent only a very small percentage of visits, they consume health care costs disproportionate to their numbers” (Milbrett & Halm, 2009, p. 191). Milbrett and Halm further state that the high utilization of services drain the system and contribute to overcrowding as well as impact the quality of care by diverting resources intended for patients in need of emergency services to those who have less urgent needs (Milbrett & Halm, 2009).

In conclusion, the frequent use of emergency services for conditions such as chronic pain management affect everyone including the facility, staff, and patients. Patients with chronic pain that misuse resources such as the emergency room cause a multitude of problems such as overcrowding. This leads to extended wait times causing patient dissatisfaction and decrease in quality care. Patients are more likely to leave a facility without seeking treatment due to long waits. Thus causing loss of revenue for the medical facility. Revenue is further lost due to nonpayment for services rendered due to no or low income. Companies also lose profit with dissatisfied nursing staff leaving the company. Ultimately, there is no gain when resources are not utilized correctly.



Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2014). Policy & politics in nursing and health care.

Milbrett, P., & Halm, M. (2009, May 2009). Characteristics and predictors of frequent utilization of emergency services. Journal of Emergency Nursing, 35, 191-198.

Wilsey, B. L., Fishman, S. M., Ogden, C., Tsodikov, A., & Bertakis, K. D. (2008, Nov-Dec). Chronic pain management in the emergency department: a survey of attitudes and beliefs. Pain Medicine, 9(1073-1080).

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