Emergency Physician Perceptions and Experiences in Acute Pain Management: A Qualitative Interview Study.

Objectives: Acute pain is the leading cause of emergency department (ED) visits in the United States, yet many patients continue to report pain at discharge despite treatment with analgesics. Although prior qualitative studies have examined patient experiences of pain management following a visit to the ED, less is known about the emergency physician (EP) perspective. This study explored EPs' perceptions and experiences managing acute pain, including perceived barriers to treatment and the consequences of inadequately managed acute pain. Methods: Semistructured interviews were conducted to elicit EPs' perceptions of challenges and barriers to acute pain management in the ED and the patient impacts of inadequately managed pain. Results: Fifteen EPs practicing in the US participated in interviews. EPs reported tailoring acute pain management strategies based on patient comorbidities, the underlying medical conditions, pain severity, and risk of pain medication-related adverse events, and risk of opioid addiction or dependence. Opioids were viewed as effective, but participants described concerns with prescribing them to at-risk patients, opioid-related adverse events, and associated administrative burdens. Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen were perceived as having tolerability issues and limited analgesic benefit. Nearly all EPs indicated inadequate pain management can have broad negative effects on patients. Conclusion: Findings suggest an unmet need for acute pain management medications that provide effective analgesia while minimizing safety concerns, administrative burden, and addiction potential.