The assessment and treatment of pain in the emergency room

A broad spectrum of painful conditions presents to the modern emergency center (EC). The three most common categories are acute, self-limited disorders; chronic medical or surgical syndromes with acute exacerbation; and psychic pain syndromes in which the etiology cannot be easily ascertained. Many factors may differentiate pain from suffering, and physicians should educate patients not only about the nature of their condition and its prognosis, but also about anticipated discomfort. Clinical concerns in the EC include physicians' tendency to undertreat or even ignore pain, the need for appropriate but flexible dosage schedules, and physicians' concern about masking important signs and symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) are currently the safest and most effective group of oral analgesics. Important factors for drug selection include efficacy, dosage, lack of side effects, and cost. Two special groups of patients, those with psychic pain syndromes and those with drug-seeking behavior, can create problems for the physician. Patients with chronic pain syndromes need special follow-up but do not benefit from additional analgesic drug therapy. Patients who seek and abuse drugs can be difficult to identify, may have true underlying medical pathology, and should not be given narcotic prescriptions.