Pain Management

Pain-related complaints represent the primary cause of concern in as many as 70% of patients presenting to the emergency department (ED). Uncontrolled pain should be considered a medical emergency, and the estimated degree of pain experienced by a patient should play a role in the determination of a patient's overall acuity and urgency for therapy. Pain estimations, using both provider- and patient-derived scales, should be obtained and recorded to determine not only the presence of pain but the response to pain therapy. In the ED, the management of acute pain should specify an initial dose of analgesic, with repeat doses titrated to a specific desired endpoint, such as pain reduction measured by a standardized assessment tool. Acetaminophen and NSAIDs should be added to pain therapy, when not contraindicated. Their analgesic effects are additive to those of opioids and to each other. Opioid therapy should be reserved for pain that has not or cannot adequately be treated with nonopioid therapies. Titrated IV opioid analgesics are the principal therapeutic approach for the treatment of moderate and severe acute pain. Ambulatory treatment with opioids should be confined to the period of acute pain. Most opioid prescriptions from the ED for acute injury should be for 3 to 5 days. Patients who are known to be diverting or abusing opioids should not be prescribed opioids for use as outpatients. Patients with chronic pain syndromes should be offered pain management options, and opioids generally should be avoided.