Management of Pain in the Emergency Department

Thomas, Stephen

doi:10.1155/2013/583132

Cited by 46 publications

(41 citation statements)

References 239 publications

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“…13 Nonsteroidal anti-inflammatory drugs (NSAIDs), another mainstay of ED pain management, also have side-effects especially in the gastrointestinal system and kidneys in the elderly. 14 Characteristics ideally required for any new analgesic modality are: efficacy, rapidity of administration, low sideeffects, minimal post-administration monitoring, improved patient satisfaction, and low cost. 9 A novel modality such as ear acupuncture might offer a solution for these issues.…”

Section: Introduction Pmentioning

confidence: 99%

Does Ear Acupuncture Have a Role for Pain Relief in the Emergency Setting? A Systematic Review and Meta-Analysis

Jan

Aldridge

Rogers

et al. 2017

Medical Acupuncture

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Objective: Ear acupuncture might be the form of acupuncture best suited to improving acute pain management in the emergency department (ED). The primary aim of this review was to assess the analgesic efficacy of ear acupuncture in the ED. Secondary outcomes included measures of patient satisfaction, adverse effects, cost, administration techniques, and reduction of medication usage. Methods: Seven databases and Google Scholar were searched up to April 27, 2017, using MeSH descriptors for three overarching themes (ear acupuncture, pain management, and emergency medicine). Meta-analyses were performed in 3 comparator groups: (1) ear acupuncture versus sham; (2) ear acupuncture-as-adjunct to standard care; and (3) ear acupuncture (both as sole therapy and adjuvant) versus control to calculate the standardized mean difference (SMD) and weighted mean difference (WMD) for pain scores out of 10. Results: Six randomized controlled trials and 2 observational studies, totaling 458 patients, were retrieved after exclusions. The meta-analysis used data from 4 randomized studies representing 286 patients. The above 3 comparator groups resulted in SMDs of 1.69, 1.68, and 1.66, and WMDs of 2.47, 2.84, and 2.61 respectively, all favoring acupuncture. Battlefield (ear) acupuncture was the most commonly used technique. There were no significant adverse effects and patient satisfaction improved. Results regarding if acupuncture reduced medication use were equivocal. Significant study bias and heterogeneity were found. Conclusions: While study numbers are limited, ear acupuncture, either as stand-alone or as-an-adjunct technique, significantly reduced pain scores and has potential benefits for use in the ED. Further studies will define acupuncture's role and if it reduces use of analgesic medications.

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Section: Introduction Pmentioning

confidence: 99%

Does Ear Acupuncture Have a Role for Pain Relief in the Emergency Setting? A Systematic Review and Meta-Analysis

Jan

Aldridge

Rogers

et al. 2017

Medical Acupuncture

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“…While the proper pain control can not only be a cause for an increase in patient satisfaction, but it also causes moving easier, faster recovery, and faster clearance of the patient from the hospital (5). One of the most important issues that the emergency physician is faced with is the choice of the type of suitable medication according to the terms of the patient and also the route of its prescription (6).…”

Section: Introductionmentioning

confidence: 99%

A Comparison between the Analgesic - Sedative Effects of Ketamine and Nitrous Oxide in Bones’ Fracture Pain Control: A Randomized Clinical Trial

Motamed

Barzegari

Verki

et al. 2017

Jundishapur J Nat Pharm Prod

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Background: Analgesics such as opioids are commonly used for pain control in emergency departments. correlated respiratory side effects and central nervous system depression confine opioids application as analgesic medication. New pain control choices such as Nitric oxide and Ketamine may be alternatives. This study evaluates efficacy of Nitric Oxide versus Ketamine in purpose of pain reduction in limbs fractures. Methods: In a randomized clinical study, 75 patients that were referred to the emergency department with pain, which has been caused by bone fractures, were randomly assigned into 2 groups: receiving ketamine with an intravenous bolus dose of 0.3 mg/kg versus mixture of 50% nitrous oxide/50% Oxygen. The pain score in the groups were measured and compared by the Visual Analog Scale consecutively at arrival and 5, 10, 15 minutes after intervention. Results: Fifteen minutes after the intervention, the score of pain in patients receiving ketamine, reached 2.5 from 8.86 at the baseline. This is while in the second group, 15 minutes after the treatment, reached to 5.02 from 9.52 at the baseline. The amount of pain reduction in both groups was statistically significant. A point-by-point comparison of the amount of the pain did not show significant differences in both groups. Conclusions: The findings of this study showed that both ketamine and Nitrous Oxide/Oxygen mixture are effective in alleviating the pain of patients with limb's fracture, however, there is no precedence between these medications as a pain killer.

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“…The cardiovascular effects of opioids are mediated centrally at the central vagal nucleus and, in the case of morphine, directly into the sinoatrial node. Within the gastrointestinal system, opioids delay gastric emptying and cause constipation [29]. There appears to be no significant differences in side effects between dosages of 0.1 mg/kg and 0.15 mg/kg.…”

Section: Morphinementioning

confidence: 93%

“…The majority of opioids used clinically target μ-opioid (mu) receptors. These receptors mediate analgesia as well as common side effects such as euphoria, constipation, and respiratory depression [29]. One exception is the combination of agonist-antagonist agents such as buprenorphine.…”

Section: Mechanismmentioning

confidence: 99%

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Acute Pain Management in the Emergency Department

Samcam¹,

Papa²

2016

Pain Management

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The most common presenting complaint to the emergency department (emergency room) is pain. Unfortunately, pain is still undertreated in this setting. Literature has shown that treatment of pain not only improves patient satisfaction but also improves mood, decreases length of hospital stay, and decreases mortality. Various pharmacological options are available for treating acute pain, ranging from oral, intravenous, and intramuscular medications; topical agents; and peripheral nerve blocks. Objectively assessing and documenting a patient's pain is the key to determining treatment. The approach to a patient with acute pain requires an experienced clinician who is aware of the pharmacology of analgesics and anesthetics, contraindications, precautions, side effects, administration methods, and monitoring requirements.This chapter briefly covers the pathophysiology of acute pain and the different treatment modalities available to the emergency physician.

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Management of Pain in the Emergency Department

Cited by 46 publications

References 239 publications

Does Ear Acupuncture Have a Role for Pain Relief in the Emergency Setting? A Systematic Review and Meta-Analysis

Does Ear Acupuncture Have a Role for Pain Relief in the Emergency Setting? A Systematic Review and Meta-Analysis

A Comparison between the Analgesic - Sedative Effects of Ketamine and Nitrous Oxide in Bones’ Fracture Pain Control: A Randomized Clinical Trial

Acute Pain Management in the Emergency Department

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