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Since pain is a primary impetus for patient presentation to the Emergency Department (ED), its
treatment should be a priority for
acute care providers. Historically, the ED has been marked by shortcomings in both the evaluation and
amelioration of pain. Over
the past decade, improvements in the science of pain assessment and management have combined to
facilitate care improvements
in the ED. The purpose of this review is to address selected topics within the realm of ED pain
management. Commencing with
general principles and definitions, the review continues with an assessment of areas of controversy
and advancing knowledge in
acute pain care. Some barriers to optimal pain care are discussed, and potentialmechanisms to
overcome these barriers are offered.
While the review is not intended as a resource for specific pain conditions or drug information, selected
agents and approaches are
mentioned with respect to evolving evidence and areas for future research.

pain is the mostcommonreason for seeking health care
and, as a presenting complaint, accounts for up to
78%of visits to the emergency department (ED).5,10,13
Adequate analgesia in EDs is an important goal of treatment;
however, the underuse of analgesics, termed oligoanalgesia,
occurs in a large proportion of ED patients (Todd, 2007)

Addressing patients pain is one of the most important

contributions ED providers can make. The frequency with
which pain is the impetus for an ED visit, the significance of
pain relief to individual patients (and family), and the relative
ease with which pain can often be ameliorated render analgesia
a primeand achievabletarget for optimization of a
patients ED care. In considering pain care in the ED, some
general principles should be kept inmind; these are reviewed
in the initial part of this discussion.The next subject to consider
is the question ofwhether there is need for discussion on
pain care in the ED. The case for focus on pain management
is bolstered by results of an assessment of the status quo
of ED analgesia practices. Rather than simply identifying
areas in which EDpractitioners are performing suboptimally,
the discussion will also include recommendations for overcoming
barriers to appropriate pain care. Specific analgesic
approaches will be addressed, with attention to various
patient populations in which analgesia care is historically
poor or controversial. (Thomas, 2013)