Pain Management in Our ED

---

Sergey Motov, MD
@painfreeED
 
General Principles:

1. Management of acute pain in the ED should be patient-centered and pan syndrome specific by using multimodal approach that include non-pharmacological modalities and pharmacological ones that include non-opioid and opioid analgesics.
2. Assessment of acute pain should be based on a need for analgesics to improve functionality, rather than patients-reported pain scores.
3. ED clinicians should engage patients in shared decision-making about overall treatment goals and expectations, the natural trajectory of the specific painful condition, and analgesic options including short-term and long-term benefits and risks of adverse effects.
4. When opioids are used for acute pain, ED clinicians should combine them with non-pharmacologic and non-opioid pharmacologic therapy: Yoga, exercise, cognitive behavioral therapy, complementary/alternative medical therapies (acupuncture); NSAID’s, Acetaminophen, Topical Analgesics, Nerve blocks, etc.
5. When considering opioids for acute pain, ED clinicians should involve patients in shared decision-making about analgesic options and opioid alternatives, risks and benefits of opioid therapies, and rational expectations about the pain trajectory and management approach.
6. When consider opioids for acute pain, EM providers should counsel patients regarding serious adverse effects such as sedation and respiratory depression; pruritus and constipation, and rapid development of tolerance and hyperalgesia
7. If acute pain lasting beyond the expected duration, complications of acute pain should be ruled out and transition to non-opioid therapy and non-pharmacological therapy should be attempted 
8. When considering administration of opioids for acute pain, ED providers should make every effort to accesses respective state’s Prescription Drug Monitoring Program (PDMP). The data obtained from PDMP’s to be used to identify excessive dosages and dangerous combinations, identify and counsel patients with opioid use disorder, offer referral for addiction treatment.