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Picture the scene…

You are about to go on your meal break when the nurse in charge of minors asks you to see “just one more”. You glance at the card, it’s a “frequent flyer” with back pain...

Learning Objective

To learn about the patient with chronic pain and their management in the ED.

RCEM Curriculum


Watch this presentation by Iain from the SMACC conference in 2014. As you watch think about how you feel when you see a “frequent flyer “heartsink” patient…

Iain Beardsell – Pain and Suffering in the ED from SMACC on Vimeo.

Read this two part blog post​1​ from Rob Orman at ERCast.

During this part of the session the facilitator should try to explore the learners’ preconceptions about patients with chronic pain. It is particularly important to emphasise that the pain they are feeling is real. Maybe use a well known patient from your own ED to illustrate this. Explore interactions that they have had that have been successful (and those that have not).

In this session we have learned about the assessment of the patient with chronic pain and how we may be able to help them when they attend the Emergency Department.


  • These patients are not drug seeking – they are seeking help.
  • Do not judge – many of these patients have tragic or traumatic events in their past that have lead to their attendance.
  • Care plans can really help in the management of these patients.

In order to embed today’s learning further, reflect on what you have learnt and record in your portfolio whether it has had any impact (or is expected to have any impact) on your performance and practice.

Was this a topic that you were confident you knew already? Which parts were new to you? Were there elements that you will use on your next clinical shift.

Dscuss this session with your colleagues – were there people who missed it who you can share the highlights with?

References and Further Reading

  1. 1
    Orman R. Chronic Pain. ER Cast Lite. 2015; published online July 29. (accessed June 9, 2020).