Do Treatment and Prescriptive Patterns Vary for Patients with Presenting with Substance Disorders than Patients with out Substance Abuse Disorders Admitted for Moderate to Severe Pain in the Emergency Department?

Wednesday, 15 July 2009: 11:25 AM

Bethany F. Sterling, RN, BSN
Nursing, Hospital of the University of Pennsylvania/University of Pennsylvania School of Nursing, Philadelphia, PA

Learning Objective 1: list current evidence based practice recommendations for care of patients presenting in pain.

Learning Objective 2: identify factors impacting pain management and treatment in patients with substance abuse disorders

Purpose: The purpose of this study is to describe the treatment and demographics of patients with moderate or severe pain in the emergency room (ER) admitted for injuries related to substance use.  Furthermore, differences between those with substance use admissions will be contrasted with admissions resulting from other reasons. The Joint Commission mandates patients have the right to have their pain assessed, treated, and monitored. Others have reported that individuals with and addiction history with pain, are less likely to receive adequate pain management than their peers.

Methods: Data was acquired from the CDC’s National Hospital Ambulatory Medical Care Survey 2005 of emergency rooms.  The sample included patients aged 18 to 64 who were admitted for an injuries that were not intentional (N= 10,967, 294 substance users).  Descriptive/graphical methods, Chi square, T-tests, ANCOVA and logistic regressions were used to explore group differences in discharge diagnoses, medication prescribed, and demographic.

Results: Graphical analysis and statistical analysis demonstrate group differences in all of the areas examined. Specifically, the rate of controlled substances prescribed differed significantly (P<0.05), indicating substance using patients received control drug at a lower rate.  

Conclusion: The literature suggests those with pain and an addiction history should be treated as if there were no history with the exception of follow-up treatment to prevent relapse.  The findings suggest that substance users have not received similar of medication for treatment of pain.  These differences maybe clinically justified or may reflect systematic bias in the management of substance abusing patients.  Therefore it is recommended additional prospective research be applied to assure the patterns found are clinically appropriate and not a function of clinician bias.  Furthermore, knowledge of the injury pain and the altered treatment of patients with substance abuse can assist nurses in advocating for appropriate pain control in the ER.