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Acute Pain Management

There are multiple barriers to adequate pain control in the ED. One is that patients may not request analgesia. In a survey, it was found that 42% of ED patients discharged without analgesics had wanted them, but 31% of that group did not specifically request them. New emphasis on patient satisfaction may drive a change here, in that effective pain control significantly improved patient satisfaction scores of ED care (n=328). So while patients may not always ask for pain relievers, they may want or expect them. Emergency clinicians practice in a unique atmosphere that emphasizes triage and often relies on the rapid transfer of patients to other clinical departments for more specialized care. The nuances of pain management can be lost in an environment that emphasizes rapid and transient care. Another barrier is clinicians’ generally inadequate training in acute pain management, reticence to use opioids, the “ED culture,” as well as personal biases. Moreover, many clinicians in and outside the ED are rightly concerned about potential adverse effects of analgesics and may hesitate to prescribe potentially harmful drugs to patients they are not going to follow. Such non-clinical factors have been shown to influence prescribing decisions. For example, in a study of opioid prescribing practices at a single center before and after the arrest of a physician for drug diversion, patients with moderate pain were significantly less likely to be prescribed an opioid immediately (<90 days) after the arrest than before (0.4 likelihood ratio, confidence interval, 0.2 to 0.7), although prescribing patterns for patients in mild and severe pain remained unchanged. Robert Taylor, Acute Pain Management in the Emergency Department: Emphasis on NSAIDs
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Last date updated on June, 2014

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