Emergency analgesia principles

SCOPE OF THE PROBLEM Pain is the presenting complaint for up to 70% of visits to the emergency department (ED). There are a myriad of strategies to treat and diagnose pain. The effective strategies are those with adequate and timely pain relief without adverse effects. In 1992, the World Health Organization developed a clinical guideline for the treatment of acute pain. This guideline includes basic instructions to select an appropriate pain medication for the patient’s pain intensity, individualize the dose by titration of opioids, and concomitantly provides adjuvant analgesic drugs as co-analgesics or to counteract side effects. It has been shown that patients frequently receive inadequate analgesia in the ED. Oligoanalgesia, the inadequate treatment of pain, frequently occurs in the ED, especially in those patients at the extremes of age and members of minority and ethnic groups. Treatment of pain is essentially a simple process, and a wide variety of agents and techniques are available that are generally effective. Morphine has been recognized as a basic treatment for pain throughout the modern era of allopathic medicine. It is effective, easy to obtain, and has never been expensive. However, morphine has severe side effects when overused, specifically in the acute setting with respiratory depression, hypotension, and a decreased ability to report worsening symptoms. Issues with the chronic use of morphine, as with all opiates, include suppression of the endorphin system with associated vegetative changes and physiologic dependence.