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Epidemiologic overview of pain treatment
in the emergency department
POLLY BIJUR
n Topics
n Trends in ED analgesia provision over time
n Heterogeneity in ED analgesia provision across demographic groups
n Introduction
The study of epidemiology includes assessment of the distribution (or maldistribution)
of healthcare resources to different segments of the population.
This chapter considers the healthcare resource of pain treatment, with focus
on findings relevant to acute care analgesia provision. The chapter discusses
the evolution of ED analgesia provision over time and overviews the clinically
relevant lessons of research into disparities in pain medication administration.
The data are primarily from the USA, but the overarching messages have
broader relevance.
n Incidence
The most comprehensive view of acute care pain treatment in the USA is
provided by the National Hospital Ambulatory Medical Care Survey
(NHAMCS), which reports a representative sample of all ED visits. For the
year 2004, the estimated number of ED visits was 18 162 million for mild pain,
26 074 million for moderate pain, and 16 617 million for severe pain. An
estimated 71 829 million analgesic medications were administered in the ED.
Using the NHAMCS terminology, 44% were narcotics, 35% NSAIDs, and 21%
non-narcotic analgesics. 1
n Analgesia provision over time
The proportion of patients in acute pain who receive analgesics has increased
over time. Two studies, carried out in 1987 and 1988, revealed extremely low
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