UI - 000070

AU - Boisaubin EV

TI - The assessment and treatment of pain in the emergency room. [Review]

AB - A broad spectrum of painful conditions presents to the modern emergency center (EC). The three

most common categories are acute, self-limited disorders; chronic medical or surgical syndromes with acute

exacerbation; and psychic pain syndromes in which the etiology cannot be easily ascertained. Many factors

may differentiate pain from suffering, and physicians should educate patients not only about the nature of

their condition and its prognosis, but also about anticipated discomfort. Clinical concerns in the EC include

physicians' tendency to undertreat or even ignore pain, the need for appropriate but flexible dosage

schedules, and physicians' concern about masking important signs and symptoms. Nonsteroidal anti-

inflammatory drugs (NSAIDs) are currently the safest and most effective group of oral analgesics. Important

factors for drug selection include efficacy, dosage, lack of side effects, and cost. Two special groups of

patients, those with psychic pain syndromes and those with drug-seeking behavior, can create problems for

the physician. Patients with chronic pain syndromes need special follow-up but do not benefit from

additional analgesic drug therapy. Patients who seek and abuse drugs can be difficult to identify, may have

true underlying medical pathology, and should not be given narcotic prescriptions. [References: 15]

SO - Clinical Journal of Pain 1989;5 Suppl 2:S19-24; discussion S24-