Improving acute pain management in emergency medicine

Abstract

Undertreatment of pain (oligoanalgesia) in the emergency department is common, and it negatively impacts patient care. Both failure of appropriate pain assessment and the potential for unsafe analgesic use contribute to the problem. As a result, achieving satisfactory analgesia while minimizing side effects remains particularly challenging for emergency physicians, both in the emergency department and after a patient is discharged. Improvements in rapid pain assessment and in evaluation of noncommunicative populations may result in a better estimation of which patients require analgesia and how much pain is present. New formulations of available treatments, such as rapidly absorbed, topical, or intranasal nonsteroidal anti-inflammatory drug formulations or intranasal opioids, may provide effective analgesia with an improved risk–benefit profile. Other pharmacological therapies have been shown to be effective for certain pain modalities, such as the use of antidepressants for musculoskeletal pain, γ-aminobutyric acid agonists for neuropathic and postsurgical pain, antipsychotics for headache, and topical capsaicin for neuropathic pain. Nonpharmacological methods of pain control include the use of electrical stimulation, relaxation therapies, psychosocial/manipulative therapies, and acupuncture. Tailoring of available treatment options to specific pain modalities, as well as improvements in pain assessment, treatment options, and formulations, may improve pain control in the emergency department setting and beyond.

Keywords:

• Acute pain
• emergency medicine
• nonsteroidal anti-inflammatory drug
• pain control
• opioids
• pain evaluation

Acknowledgments

Editorial support was sponsored by Iroko Pharmaceuticals, LLC (Philadelphia, PA) and provided by Jill See, PhD, and Colville Brown, MD, of AlphaBioCom, LLC (King of Prussia, PA). The sponsor had no editorial input on this manuscript, and the authors received no payment for their work.

Declaration of interest

Charles V. Pollack Jr, MA, MD, FACEP, is a consultant to Luitpold Pharma, from which he has also received research funding, and has also received consulting fees from Iroko Pharmaceuticals. LLC. Eugene R. Viscusi, MD, is a consultant to AcelRx, Mallinckrodt, Cubist, Pacira, and Salix. He is a speaker for Mallinckrodt, Cubist, and Salix. His university has received research funding from AcelRx, Cumberland, and Pacira.

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