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A Challenging Case of Chronic Pain in the Emergency Department: Medical and Ethical Issues of Management

Reinisch, Courtney MSN, RN, APN-C

Section Editor(s): Hayes, Karen

Advanced Emergency Nursing Journal: January-March 2007 - Volume 29 - Issue 1 - p 35–40

Pain is a common problem seen in all areas of healthcare including the emergency department (ED). Chronic pain is a condition that requires specialized management. EDs provide episodic care and are often faced with the challenge of managing patients with chronic pain. Some of these patients present with drug-seeking behaviors that make it difficult to provide appropriate care for their condition. This article presents a case of a patient with chronic migraine headache, and the ethical issues surrounding her management in an ED, with focus on the patient's autonomy, and the concepts of nonmalficence, beneficence, and informed consent. This article concludes with recommendations for ED to appropriately and safely manage patients with chronic pain.

Robert Wood Johnson University Hospital, Hamilton, NJ; and the School of Nursing, Columbia University, New York, NY.

Corresponding author: Courtney Reinisch, MSN, RN, APN-C, School of Nursing, Columbia University, New York, NY 10032 (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.