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Pain management in the ED.

Barth Wilsey1, Scott Fishman, John S Rose

  • 1Northern California Veterans Administration Pain Clinics, Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, California, USA. blwisely@ucdavis.edu

The American Journal of Emergency Medicine
|January 16, 2004
PubMed
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Emergency department (ED) physicians face challenges in pain management due to opioid controversies. This review addresses pitfalls in ED pain management and offers recommendations for appropriate prescribing.

Area of Science:

  • Emergency Medicine
  • Pain Management
  • Pharmacology

Background:

  • Recent regulatory and legal scrutiny surrounds pain treatment, focusing on opioid over- and undertreatment.
  • Concerns include overly aggressive opioid prescribing and barriers to appropriate medication access.
  • Media attention on controlled substance diversion intensifies the debate, particularly for nonmalignant pain.

Purpose of the Study:

  • To review the challenges and pitfalls in emergency department (ED) pain management.
  • To provide recommendations for appropriate pain medication prescribing in the ED.

Main Methods:

  • This is a review article synthesizing current knowledge and expert opinion.
  • It focuses on the role of Emergency Physicians (EPs) in pain management controversies.

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Main Results:

  • EDs commonly encounter patients with pain, making EPs central to prescribing debates.
  • Pitfalls in pain management include both overtreatment and undertreatment of pain.
  • Inappropriate prescribing practices, including diversion, are significant concerns.

Conclusions:

  • Emergency physicians must possess robust pain management skills.
  • Balancing appropriate pain relief with preventing misuse of controlled substances is crucial.
  • Recommendations are provided for managing pain in selected conditions within the ED setting.