Acute Pain Management
Pain is the main reason for consultation in Emergency Departments (ED), representing up to 78% of them and a third of them manifesting severe pain. Despite the frequency of this problem, pain treatment is far from optimal, with high rates of oligo analgesia. The inadequate use of drugs such as duplication of mechanisms of action, interactions, inappropriate drugs, and incorrect doses to the patient’s scenario and profile, with a high incidence of adverse effects, has been proven.
This article presents recommendations for the most frequent scenarios to be resolved in emergency departments.
A standard of care should be developed: from non-pharmacological strategies to protocolized therapeutic regimens with the vision of making the ED a place of comprehensive and humanized pain management.
Pain is the main cause of visits to the Emergency Department (ED), reaching up to 78% of consults and one-third of them manifesting severe pain. Despite how frequent are these, the chief complaint the treatment of pain is far from optimal, with high rates of oligo analgesia. The inadequate use of drugs such as duplication of mechanisms of action, interactions, inappropriate drugs, and incorrect doses to the scenario and profile of the patient has been verified, with a high incidence of adverse effects.
This article presents recommendations for the most frequent scenarios to be solved in emergency departments.
A standard of care should be developed: from non-pharmacological strategies to protocolized medication plans with the vision of making the ED a place with comprehensive and humanized pain management.
Pain is the most frequent cause of consultation in the Emergency Department (ED), being reported by 78% of patients, and one-third of them manifesting severe pain (scale equal to or greater than 7/10).
The importance of pain management has ethical and professional grounds 6, but also important consequences on patient satisfaction. It is important to take this point into account because satisfied patients tend to respond better to treatment. Furthermore, working in an environment with good patient satisfaction reduces malpractice claims and improves the professional satisfaction of staff members 8. For this reason, pain assessment has been considered another vital sign, so much so that most standardized Triage methods incorporate the magnitude of pain in their algorithms. From another perspective, standardized pain management programs reduce the costs of medical care with more appropriate use of resources in the in-hospital setting, in addition, the specialized management of patients with chronic pain reduces the demand for emergency care, reducing another factor of “overcrowding” or overcrowding of emergency units 9.
On the other hand, it should be considered that pain is not the only source of a patient suffering in the emergency department: diagnostic uncertainty, waiting times, nausea, dyspnea, and the economic problems involved in the consultation, to mention just a few aspects, are all sources that can contribute to the patient’s distress. Relief of physical pain is only one pillar of comprehensive patient care, and is of great relevance, in addition to taking the time to explain, being empathetic, reassuring the patient, looking for good attention times 1, and other strategies, which can make the patient have a good experience in the ED.
The evaluation of the quality of pain management in the ED is not yet standardized. The Joint Commission, in its 5th edition of standards for hospital accreditation 10, publishes the following within its patient-centered standards:
PFR: Patient and family right Patient and family rights. The hospital supports the patient’s right to pain assessment and management and to respectful and compassionate care at the end of life. Go to this site for more tips on pain management.