Emergency Medicine: Open Access
Open Access

Abstract

Acute Pain Management in the Emergency Department: Emphasis on NSAIDs

Srinivas Nalamachu, Joseph V Pergolizzi, Robert B Raffa and Robert Taylor

Millions of patients are treated every year for acute pain symptoms in the Emergency Department (ED), but pain control in this setting still remains suboptimal. This may be due to the logistical challenges in the ED, ED clinicians’ limited education and training in pain control, regulatory and legal concerns, and other barriers to prescribing. The most common analgesics used in the ED are acetaminophen (paracetamol), Non Steroidal Anti-Inflammatory Drugs (NSAIDs), and opioids. All are effective in relieving pain, but are also associated with serious side effects. Thus, pain control in the ED becomes a balancing act of weighing potential benefits and risks. NSAIDs are often the appropriate choice for many of the common acute pain conditions encountered in the ED, but because of risks associated, administration is often limited. A review of the literature regarding current ED pain treatment practices and guidelines, patient and clinician barriers to pain treatment in the ED, and the pros and cons of current analgesic options for the ED is warranted and timely. The objectives of the current review are to: (1) provide healthcare providers with an overview of the current state of acute pain treatment in the emergency room setting, (2) describe the common drug treatments utilized in emergency medicine, (3) review advantages and disadvantages of these treatments, with a focus on NSAIDs, and (4) examine the potential value of novel “low dose” NSAID formulations for use in this setting.