Acute Care MedicineCritical CareEmergency MedicineEthics in HealthcareEmergency management of chronic pain

Emergency Management of Chronic Pain

In the Emergency Management of Chronic Pain podcast, Duncan Grossman and Reuben Strayer discuss how and why patients with chronic pain present to the ED.

Managing patients with chronic pain is challenging and often it feels like these patients present to the ED during every shift. But… is it as common as it feels?

Statistics suggest that 20% of American adults suffer from chronic pain.

Why? Well, opioids are both the disease and the cure.

Opioids are effective for managing acute pain. However, when they are used for (even) more than a couple of days they can start to cause pain.

Therefore, we have to understand the spectrum of opioid benefit vs harm.

Reuben and Duncan discuss a framework that accounts for the relationship between chronic pain and opioid use. Noting that each patient presents a unique challenge.

Take for example, the patient who is on daily, low dose opioids but is otherwise unaffected by their pain medication.

Or, the patient who has chronic pain but doesn’t take opioids. We need to be careful here as these patients can be more susceptible to developing an addiction from prescribed opioids due to their ongoing pain.

What about the patient who takes opioids daily but is buying them off the street…

Reuben takes us through some strategies for helping all of these patients. One such strategy is to talk to the prescribers. We need to help these patients by encouraging their prescribers to take the reins and to move the needle from opioid harm to opioid benefit.

Tune in as Duncan Grossman grills Reuben Strayer on chronic pain in patients, how to manage them and how to help them.

For more like this, head to our podcast page #CodaPodcast

Reuben Strayer

Reuben Strayer was born on the shores of Lake Michigan but raised and schooled in Texas until emigrating to balmy Montreal for a residency in emergency medicine and is now based in New York City. His clinical areas of interest include airway management, analgesia, opioid misuse, procedural sedation, agitation, decision-making and error. His extra-clinical areas of interest include sweeping generalizations and jalapeno peppers. He lures himself out of bed with chocolate dipped in peanut butter before heading to Maimonides Medical Center, in Brooklyn, where he is happily employed.


Duncan Grossman

Duncan Grossman completed his emergency medicine residency at Maimonides Medical Center in Brooklyn, NY and is now the medical education fellow at St. Joseph’s University Medical Center in Paterson, NJ.