Background: Patients with   chronic noncancer pain (CNCP) present unique challenges to emergency   department (ED) care providers and administrators. Their conditions lead to   frequent ED visits for pain relief and symptom management and are often   poorly addressed with costly, low-yield care. A systematic review has not   been performed to inform the management of frequent ED utilizing patients   with CNCP. Therefore, we synthesized the available evidence on interventional   strategies to improve care-associated outcomes for this patient group. 

Results: Thirteen studies including   1,679 patients met the inclusion criteria. Identified interventions   implemented pain policies (n = 4), individualized care plans (n = 5), ED care   coordination (n = 2), chronic pain management pathways (n = 1), and   behavioral health interventions (n = 1). All of the studies reported a   decrease in ED visit frequency following their respective interventions.   These reductions were especially pronounced in studies whose interventions   were focused around individualized care plans and primary care involvement.   Interventions implementing opioid restriction and pain management policies   were largely successful in reducing the amounts of opioid medications   administered and prescribed in the ED. 

Conclusions: Multifaceted interventions, especially those employing   individualized care plans, can successfully reduce subsequent ED visits, ED   opioid administration and prescription, and care-associated costs for   frequent ED utilizing patients with CNCP.

Authors: Charles K. Wong,Connor M. O'Rielly, Braden D. Teitge, Robert L. Sutherland, Scott Farquharson, Monty Ghosh,Helen L. Robertson, Eddy Lang MD,