Chronic pain management in the ED For context I am a new EM attending and really struggling with the current management of chronic pain patients in my hospital system. More specifically we have a group of patients with sickle cell disease who are in the ED daily and have pain plans with 3-4 mg dilaudid q1H. If they still have pain after 3 doses they get admitted on a PCA dilaudid pump. I have see many of them leave AMA when their PCA is turned off and represent to the ED wanting another round of Q1H doses. On labs their retic count isn’t elevated, no infection/O2 requirement or their objective findings of crisis. I’ve talked with my medical director and peers and a lot of us feel they are needing the ED more and more frequently is opioid withdrawal pain as opposed to sickle cell crisis. Whenever we have any other opioid seeking patients even with other very painful conditions like endometriosis, fibromyalgia, arthritis etc we don’t give them multiple rounds of IV opioids without question.…