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Acute pain

Key sources
The following summarized guidelines for the evaluation and management of acute pain are prepared by our editorial team based on guidelines from the United States Department of Defense (DoD/VA 2022), the Center for Disease Control (CDC 2022), and the European Society for Emergency Medicine (EUSEM 2020).


1.Diagnostic investigations

Clinical examination: review observed signs of pain alongside patient self-reports, including HR, respiratory rate, facial expressions, or patient expressions of pain (such as groaning). Use these observations in conjunction with the patient's own evaluation, as alone those can under- or overestimate pain intensity.
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  • Assessment scales

2.Medical management

General principles
Consider using multimodal analgesia, an approach involving the combination of opioid and non-opioid analgesics acting at different sites within the pain pathway to provide an additive or synergistic effect, to optimize outcomes in the treatment of patients with acute pain, reduce opioid-related side effects and prevent chronic pain.
Administer rapidly acting IV agents in small doses at frequent intervals until pain relief is achieved to allow the determination of the patient's individual requirements before long-acting medications or patient-controlled analgesia are initiated.

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  • Non-opioid analgesics (paracetamol)

  • Non-opioid analgesics (NSAIDs)

  • Non-opioid analgesics (dipyrone)

  • Opioids

  • Ketamine

  • Inhaled analgesics (nitrous oxide)

  • Inhaled analgesics (methoxyfurane)

3.Nonpharmacologic interventions

Attentional control: advise attention control methods including distraction techniques, concentration and focus on external stimuli using music, imagery, controlled breathing, breastfeeding for infants and play for adult and pediatric patients
. Recognize that virtual reality is emerging as a potential technique to occupy patients.

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  • Cold and heat therapy

  • Acupressure

4.Therapeutic procedures

Transcutaneous electrical nerve stimulation: recognize that transcutaneous electrical nerve stimulation has demonstrated evidence from postoperative settings that it can significantly reduce analgesic requirements.

5.Specific circumstances

Patients with fractures: recognize that:.
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6.Patient education

General counseling: be aware that it is important to patients that clinicians recognize their patients' pain, acknowledge it, in doing so validate the patient's situation, and if feasible to empathize with the patient.

7.Follow-up and surveillance

Monitoring of analgesia: reassess patients once analgesia has been provided, to ensure that their pain is being successfully managed, and reassess their pain relief regimen regularly during their stay in the emergency department.