Abstract
Purpose of the Review
The safe and effective treatment of acute pain is a complex and challenging area for clinicians. In this review we use three cases describing common clinical scenarios to discuss the safe and appropriate use of opioid analgesics.
Review Findings
Opioids are effective and can be used safely for the treatment of acute pain, but have predictable and dose dependent adverse effects. As the dose of opioid increases, respiratory depression, somnolence, and confusion become predominant adverse effects. As the duration of the treatment increases, their safety and effectiveness decreases. In general, a patient that requires regular opioid treatment for more than 5 days will require dose tapering to avoid withdrawal symptoms. Opioids are generally not considered safe for the treatment of mild pain, and their use for chronic pain is controversial.
Summary
Opioid medications represent a safe and effective approach to the treatment of acute pain. Their safe use requires monitoring for and treatment of their adverse effects. The best approach for using opioids is to select the opioid with the onset, duration, and adverse effects that best suit a patient’s condition and pain, titrate it to adequate pain relief, continue to the medication at this level to treat the pain, and develop a plan to discontinue the medication safely.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of great importance
Cordell WH, Keene KK, Giles BK, Jones JB, Jones JH, Brizendine EJ. The high prevalence of pain in emergency medical care. Am J Emerg Med. 2002;20(3):165–9.
Fosnocht DE, Swanson ER, Bossart P. Patient expectations for pain medication delivery. Am J Emerg Med. 2001;19(5):399–402.
•• Miner J, Biros MH, Trainor A, Hubbard D, Beltram M. Patient and physician perceptions as risk factors for oligoanalgesia: a prospective observational study of the relief of pain in the emergency department. Acad Emerg Med. 2006;13(2):140–146. This mansucript discusses the risks of pain assesment based on patient characteristics.
Todd KH, Ducharme J, Choiniere M, et al. Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study. J Pain. 2007;8(6):460–6.
Fosnocht DE, Swanson ER, Barton ED. Changing attitudes about pain and pain control in emergency medicine. Emerg Med Clin North Am. 2005;23(2):297–306. This manuscript provides a broad look at the spectrum of acute pain presenting to the ED.
•• Fischer B, Gooch J, Goldman B, Kurdyak P, Rehm J. Non-medical prescription opioid use, prescription opioid-related harms and public health in Canada: an update 5 years later. Canadian J Publ Health = Rev can de sante publique. 2014;105(2):e146–149. This manuscript provides an overview of the risk of abuse with the use of outpatient opioids.
Hendrikson H. Preventable deaths on the rise: growing numbers of overdoses, suicides, and brain injuries have lawmakers searching for solutions. State Legis. 2013;39(10):30–1.
Paulozzi LJ, Weisler RH, Patkar AA. A national epidemic of unintentional prescription opioid overdose deaths: how physicians can help control it. J Clin Psychiatr. 2011;72(5):589–92.
Phillips J. Prescription drug abuse: problem, policies, and implications. Nurs Outlook. 2013;61(2):78–84.
Fosnocht DE, Hollifield MB, Swanson ER. Patient preference for route of pain medication delivery. J Emerg Med. 2004;26(1):7–11.
• Birnbaum A, Esses D, Bijur PE, Holden L, Gallagher EJ. Randomized double-blind placebo-controlled trial of two intravenous morphine dosages (0.10 mg/kg and 0.15 mg/kg) in emergency department patients with moderate to severe acute pain. Ann Emerg Med. 2007;49(4):445–453, 453:e441–442. This manuscript provides an overview of the basic use of morphine in acute pain.
Chang AK, Bijur PE, Lupow JB. John Gallagher E. Randomized clinical trial of efficacy and safety of a single 2-mg intravenous dose of hydromorphone versus usual care in the management of acute pain. Acad Emerg Med. 2013;20(2):185–92.
Choe D, Hernandez L, Birnbaum A. Does initial hydromorphone relieve pain best if dosing is fixed or weight based? Ann Emerg Med. 2014;63(6):692–8.
Birnbaum A, Schechter C, Tufaro V, Touger R, Gallagher EJ, Bijur P. Efficacy of patient-controlled analgesia for patients with acute abdominal pain in the emergency department: a randomized trial. Acad Emerg Med. 2012;19(4):370–7.
McHale PM, LoVecchio F. Narcotic analgesia in the acute abdomen–a review of prospective trials. Eur J Emerg Med. 2001;8(2):131–6.
Neighbor ML, Baird CH, Kohn MA. Changing opioid use for right lower quadrant abdominal pain in the emergency department. Acad Emerg Med. 2005;12(12):1216–20.
Thomas SH, Silen W, Cheema F, et al. Effects of morphine analgesia on diagnostic accuracy in Emergency Department patients with abdominal pain: a prospective, randomized trial. J Am Coll Surg. 2003;196(1):18–31.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Dr. Scott and Dr. Miner declare no conflict of interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by the author.
Additional information
This article is part of the Topical Collection on Pain Management in Adults.
Rights and permissions
About this article
Cite this article
Miner, J.R., Scott, N.L. The Safe and Rational Use of Analgesics: Opioid Analgesics. Curr Emerg Hosp Med Rep 4, 153–157 (2016). https://doi.org/10.1007/s40138-016-0103-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40138-016-0103-4