Willingness to use nonpharmacologic treatments for musculoskeletal pain in the emergency department: a cross-sectional study.
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ObjectivesPain is an individual experience that should incorporate patient-centered care. This study seeks to incorporate patient perspectives toward expanding nonpharmacologic treatment options for pain from the emergency department (ED).
MethodsIn this cross-sectional study of adult patients in ED with musculoskeletal neck, back, or extremity pain, patient-reported outcomes were collected including willingness to try and prior use of various nonpharmacologic pain treatments, sociodemographics, clinical characteristics, functional outcomes, psychological distress, and nonmusculoskeletal symptoms. Least absolute shrinkage and selection operator regression identified variables associated with (1) willingness to try and (2) having previously tried nonpharmacologic treatments.
ResultsResponses were analyzed from 206 adults, with a mean age of 45.4 (SD 16.4) years. The majority (90.3%) of patients in ED were willing to try at least one form of nonpharmacologic pain treatment, with 70.4%, 81.6%, and 70.9% willing to try respective subcategories of active (eg, exercise), passive (eg, heat), and psychosocial (eg, prayer) modalities. Only 56.3% of patients had previously tried any, with 35.0%, 52.4%, and 41.3% having tried active, passive, and psychosocial modalities, respectively. Patient-level factors associated with willingness included pain in upper back, more severe pain-related symptoms, and functional impairments. The factor most consistently associated with treatment use was health care provider encouragement to do so.
ConclusionsPatients in ED report high willingness to try nonpharmacologic treatments for pain. Higher pain severity and interference may indicate greater willingness, while health care provider encouragement correlated with treatment use. These findings may inform future strategies to increase the introduction of nonpharmacologic treatments from the ED.
Published Version (Please cite this version)
Eucker, Stephanie A, Shawna Foley, Sarah Peskoe, Alexander Gordee, Thomas Risoli, Frances Morales and Steven Z George (2022). Willingness to use nonpharmacologic treatments for musculoskeletal pain in the emergency department: a cross-sectional study. Pain reports, 7(5). p. e1027. 10.1097/pr9.0000000000001027 Retrieved from https://hdl.handle.net/10161/25666.
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Stephanie Eucker, MD, PhD, FACEP is an Assistant Professor and Assistant Director of Acute Care Research in the Duke University Department of Emergency Medicine. Her primary research interest is in preventing and treating chronic pain, disability, and opioid use disorder (OUD) by incorporating innovative multimodal and nonpharmacologic pain management strategies in the Emergency Department (ED). Her broad clinical and research training includes Emergency Medicine, Bioengineering, Clinical and Translational research. Her research comprises three main synergistic areas of focus: (1) innovative nonpharmacologic ED pain care models, (2) patient-centered, personalized medicine approaches to pain care selection, and (3) transforming ED care best practices.
In the nonpharmacologic realm, Dr. Eucker is PI of a SAMHSA-funded pragmatic randomized clinical trial of acupuncture to treat acute musculoskeletal pain in the ED, to which her team has successfully recruited 599 patients with >50% identifying as African-American and/or Latinx. Her team successfully developed an approach to acupuncture that is feasible for the fast-paced ED setting, produces significantly greater pain reductions than usual care alone, and is used and rated highly acceptable by diverse ED patients with acute musculoskeletal pain.
In the patient-centered focus, she leads several ongoing studies investigating the relationship between biopsychosocial factors and pain-related outcomes in ED patients, patient expectations for ED pain management, and the relationship between post-ED care pathways and downstream opioid use.
Regarding research on improving and implementing ED best practices, Dr. Eucker is site-PI for the multi-site PROCOVAXED study aiming to improve COVID-19 vaccination rates among ED patients through multi-media informational platforms. She has been a co-investigator in a multi-center AHRQ implementation study to improve safe ED prescribing for older adults. She also leads a multi-professional quality improvement and research effort to improve naloxone and buprenorphine prescribing for ED patients with opioid overdose and OUD. She has also partnered with Durham County and other community partners to improve linkages to care through peer support specialists in the ED.
Regarding training, Dr. Eucker has mentored numerous trainees in research, including undergraduates, graduate students, medical student, resident physicians, physician assistants and junior faculty over the past several years. She is highly experienced at engaging learners at their level of understanding and interest in the research process, from novice researchers to those with extensive experience. Her mentees have coauthored numerous publications and progressed to leading projects under her mentorship.
Dr. George’s primary interest is research involving biopsychosocial models for the prevention and treatment of chronic musculoskeletal pain disorders. His long term goals are to 1) improve accuracy for predicting who is going to develop chronic pain; and 2) identify non-pharmacological treatment options that limit the development of chronic pain conditions. Dr. George is an active member of the American Physical Therapy Association, United States Association of the Study of Pain, and International Association for the Study of Pain.
Dr. George’s research projects have been supported by the National Institutes of Health, Department of Defense, and Orthopaedic Academy of the American Physical Therapy Association. Dr. George and his collaborators have authored over 300 peer-reviewed publications in leading medical, orthopaedic surgery, physical therapy, rehabilitation, and pain research journals. He currently serves as Deputy Editor for Physical Therapy and is an Editorial Board Member for the Journal of Pain. Dr. George has also been involved with clinical practice guideline development for the Academy of Orthopaedic Physical Therapy and the American Psychological Association.
Dr. George has been recognized with prestigious research awards from the American Physical Therapy Association, American Pain Society, and International Association for the Study of Pain. For example from the American Physical Therapy Association: he was named the 21st John H.P. Maley Lecturer, recognized as a Catherine Worthingham Fellow in 2017, and selected for the Marian Williams Award for Research in Physical Therapy in 2022.
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