title: 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.
authors.affiliation: Professor, Department of Emergency Medicine, Perelman School of Medicine of the University of Pennsylvania, and Chairman, Department of Emergency Medicine, Pennsylvania Hospital , Philadelphia, PA , USA.
authors.forename: Charles V
authors.initials: CV
authors.lastname: Pollack
authors.forename: Eugene R
authors.initials: ER
authors.lastname: Viscusi
mesh_terms: D015670:Acupuncture Therapy; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002211:Capsaicin / Q000627:therapeutic use; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D018755:GABA Agonists / Q000627:therapeutic use; D006801:Humans; D059408:Pain Management / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D004561:Transcutaneous Electric Nerve Stimulation
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D016861:Cyclooxygenase Inhibitors; D018755:GABA Agonists; D002211:Capsaicin
keywords: Acute pain; emergency medicine; nonsteroidal anti-inflammatory drug; opioids; pain control; pain evaluation