Emergency department pain management in special populations

Pain is a leading cause of emergency department (ED) visits globally, yet certain patient populations experience persistent disparities in their pain management due to physiological complexities, comorbidities, and gaps in evidence-based guidelines. This clinical review focuses on individualized, evidence-based approaches to ED pain management in four vulnerable groups: pregnant and breastfeeding patients, patients with sickle cell disease, geriatric populations, and patients with cancer pain and requiring palliative care. The practical recommendations presented in this review for optimal ED pain management in these special populations call for timely, effective, and multimodal analgesia; prioritization of nonpharmacologic and pain syndrome-targeted techniques; awareness of drug-disease and drug-drug interactions; interdisciplinary coordination; and education to mitigate ED clinicians' biases. This review emphasizes the importance of tailoring pain strategies to population-specific needs to improve outcomes, reduce harm, and advance equity in emergency care delivery.