Original Contribution A qualitative study of the barriers to chronic pain management in the ED B Barth L. Wilsey MD a,b, ⁎ , Scott M. Fishman MD b , Margie Crandall RN, PhD c , Carlos Casamalhuapa BS b , Klea D. Bertakis MD, MPH d a VA Northern California Health Care System, Sacramento, CA 95655, USA b Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, Sacramento, CA 95817, USA c Department of Patient Care Services, Center for Nursing Research, University of California, Davis Medical Center, Sacramento, CA 95817, USA d Department of Family Practice, University of California, Davis Medical Center, Sacramento, CA 95817, USA Received 17 April 2007; revised 8 May 2007; accepted 11 May 2007 Abstract Purpose: This qualitative study sought to identify perceived barriers to diagnosing and treating patients with chronic pain in the emergency department (ED). Basic Procedure: Semistructured interviews were conducted with 24 ED physicians from 4 hospitals to elucidate their experiences of managing chronic pain in the ED. Main Findings: Time limitations and a low triage priority were major barriers to caring for patients with chronic pain. But despite the inherent problems of treating a nonurgent condition in a time-limited setting, physicians were strong proponents for treating chronic pain in the ED. Principal Conclusion: Acknowledging that pain can neither be verified nor disproved, physicians tend to err on the side of the patient, often providing an allotment of opioid medications. They also believe that the ED is not an optimal setting for treating patients in chronic pain but that it is often the last resort for many of these patients, thus, providing the rationale for serving them to the best of their ability. © 2008 Elsevier Inc. All rights reserved. 1. Introduction 1.1. Background A large body of evidence suggests that the undertreatment of chronic pain is a serious public health problem that can decrease patients' functional status and quality of life [1]. Circumstances that contribute to the prevalence of under- ☆ This study was supported by a grant from Mayday Fund, c/o SPG, 136 West 21st Street, 6th Floor, New York, NY 10011. ⁎ Corresponding author. Pain Academic Office, UC Davis Medical Center, 3020 Ellison Ambulatory Care Center, Sacramento, CA 95817, USA. Tel.: +1 916 734 7836; fax: +1 916 734 6827. E-mail address: blwilsey@ucdavis.edu (B.L. Wilsey). www.elsevier.com/locate/ajem 0735-6757/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.ajem.2007.05.005 American Journal of Emergency Medicine (2008) 26, 255–263