Medical Management of Pain in the Emergency Setting Without Narcotics: Current Status and Future Options
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Purpose of Review
Relief of pain and discomfort is a critical component of the mission of every health care provider to reduce suffering. Pain management is of paramount importance in the provision of care at every level. This is an era of increasing patient expectations of care, yet also there exists an ongoing scourge of opiate abuse.
ED visits for opioid overdoses rose 30% in all parts of the USA from July 2016 through September 2017. Deaths from narcotic overdose in the USA now exceed those from motor vehicle crashes. The concept of an “opiate-free” emergency department has been posited.
The emergency practitioner is presented with clinical and political challenges which did not exist in the past. This article elucidates current pharmacologic options regarding analgesia in the emergency setting, with some possible future options.
KeywordsEmergency practice guidelines Pain management Opiate abuse Non-opioid analgesics
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 5.Bellon T,. US state lawsuits against Purdue pharma over opioid epidemic mount. Reuters World, 2018.Google Scholar
- 6.• Centers for Disease Control and Prevention. MMWR. Vital signs: trends in emergency department visits for suspected opioid overdoses—United States July 2016–September 2017. 2018;67:1–8. Reinforces societal trends in opioid use and abuse.Google Scholar
- 7.Centers for Disease Control and Prevention. CDC Vital Signs. Opioid overdoses treated in emergency departments: identify opportunities for action. March 6, 2018 Available at www.cdc.gov/opioid-overdoses
- 8.ACEP 911 Weekly Update, April 27, 2018, May 11, 2018. Opioid bills move forward in house and senate.Google Scholar
- 10.Joint Commission Accreditation of Healthcare Organizations. CAMH revised pain management standards. 2000 Available at http://www.jointcommission.org/standards_information/standards.aspx.
- 19.Centers for Disease Control and Prevention (CDC). CDC Grand Rounds: prescription drug overdoses—a US epidemic. MMWR Morb Mortal Wkly Rep. 2012;61:10–3.Google Scholar
- 20.Fentanyl: the latest scourge. The Economist May 20, 2017: 13–14.Google Scholar
- 24.CDC guideline for prescribing opioids for chronic pain—United States 2016. MMWR Recomm Rep 2016; 65 (RR-1): 1–49.Google Scholar
- 26.Krebs EE, Gravely A, Nugent S, Jensen AC, DeRonne B, Goldsmith ES, et al. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA. 2018;319(9):872–82.CrossRefPubMedGoogle Scholar
- 28.American Society of Anesthesiologists. Practice guidelines for acute pain management in the perioperative setting. Anesthesiology. 116(2):248–73.Google Scholar
- 29.Wick EC, Grant MC, Wu C. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques. JAMA Surgery. 2017:E1–7.Google Scholar
- 31.Drugs.com Ketorolac Injection.
- 38.Bell RF, Dahl JB, Moore RA, Kalso E. Perioperative ketamine for acute postoperative pain. Cochrane Database Syst Rev. 2006;1:CD0004603.Google Scholar
- 41.Ducharme J. Non-opioid pain medications to consider for emergency department patients. ACEP Now 2015; 35(5).Google Scholar
- 48.•• New painkiller studies: working toward non-addictive painkillers, posted in Prescription Drugs December 28, 2017. Available at www.promises.com/articles/prescription-drugs/new-painkiller-studies-woking-towarde. Accessed April 11, 2018. Discussion of future trends and development of alternative analgesics.