Chronic pain and frequent use of emergency department: A systematic review

Emergency department (ED) overcrowding is an important issue in healthcare worldwide. A small group of patients account for a disproportionate number of ED visits and a few studies have suggested that chronic pain (CP) sufferers may be part of that group. The aim of this study was to review all studies having examined the association between CP and frequent use of ED services.

A systematic review of the literature was performed. The CINAHL, PsycINFO, PubMed and Scopus databases were searched from January 1997 to August 2019, using a strategy containing the keywords frequent use, CP and ED. Two independent reviewers screened articles and assessed methodological quality using the Joanna Briggs Institute tool for prevalence studies. To be included in the review, studies had to: (1) document frequent use of ED services; (2) evaluate CP patients; and (3) use regression models. Studies were excluded if they addressed cancer pain; evaluated an intervention; or targeted an exclusively paediatric population. A narrative synthesis was conducted.

Of the 1182 articles identified, 927 remained after removing duplicates and 47 remained after the evaluation of titles and abstracts, which were read completely. Finally, five articles, published between 2004 and 2016, were included in the study. Every study showed that CP was associated with higher ED visits. Two studies documented that frequent users had a higher level of disability than non-frequent users, or that disability was associated with frequent use.

This review suggests that CP is associated with frequent use of ED services.