Hurting for Options: Emergency Department Utilization for Chronic Pain in a Safety-Net Hospital

Patients with chronic pain frequently visit the emergency department (ED) due to accessibility of care, but the impact is underestimated. This study examines the prevalence and characteristics of patients who visited the ED for chronic pain at an urban safety-net hospital.

A systematic sampling strategy was used to survey adult ED patients between June and August 2024. We categorized participants who visited the ED as having (1) chronic pain, (2) acute pain, or (3) nonpain conditions. The study collected data on self-reported demographics and health access information, and hospital records on ED wait time, length of stay, insurance, and arrival time. Chi-square tests and regression models compared differences across groups.

Of the 602 participants (64% Medicaid, 78% Hispanic/Latino), 18% visited the ED for chronic pain. This group of participants was more likely to report worse health status, visiting the ED as a usual place for care, despite being more likely to have seen a health care provider within a week before their ED visit. Furthermore, they had a longer ED length of stay and were more likely to arrive after business hours (4:30 pm) and perceive their ED visit as an emergency compared to those who visited the ED for acute pain and nonpain conditions. There is no difference in ED workup, specialty service involvement, and consultation.

Chronic pain is highly prevalent in a safety-net ED patient population. Patients with chronic pain present to the ED because they feel the condition is emergent. The lack of different ED treatment strategies highlights that perhaps ED providers have a general approach to painful conditions regardless of chronicity. Health systems need to better assess the burden of chronic pain in the ED and develop programs to help manage such patients in an effective and efficient manner.