Erica Liebelt Nadine Levick
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In both the United States and the United Kingdom, in excess of 60 percent of all emergency department (ED) patients present with conditions associated with pain. However, inadequate analgesia continues to be documented in the ED setting. Acute pain management consists of pain relief and anxiolysis with preservation of airway reflexes and consciousness. The Agency for Health Care Policy and Research (AHCPR) guidelines for acute pain management1 are a useful guide but should be supplemented with more detailed and current information.2
The experience of pain is determined by many factors, including medical condition, developmental level, emotional and cognitive state, personal concerns, meaning of pain, family issues and attitudes, culture, and environment. Fear and anxiety accentuate physical pain. Effective pain management should address psychological and physical aspects by using both nonpharmacologic and pharmacologic modalities.
The utility of oral medications in the ED is limited because emergent operative or investigational procedures often mandate NPO status, and gastrointestinal absorption may be poor because of the patient's underlying condition. Repeated intramuscular doses of narcotic analgesia no longer represent an approach of choice except in patients where vascular access must be preserved (sickle cell patients). A multifaceted approach combining titrated intravenous medications, regional and topical medications, adequate anxiolysis, and incorporation of nonpharmacologic techniques to enhance patient care and comfort is preferred.
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