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34 Epidemiologic overview of ED pain treatment Distribution of pain treatment by race and ethnicity (cont.) Author (year data collected) Quintans- Rodriquez 13 (1998–9) Tamayo- Sarver 4 (1997–9) Neighbor 7 (1999) Bijur (2000–2) unpublished Miner 6 (2003–4) Condition Patient type (n) Received any analgesics (%) Long-bone fracture Long-bone fracture White (181) African-American (58) Hispanic (46) White (602) African-American (80) Hispanic (71) Back problems White (912) African-American (273) Hispanic (126) Migraine White (471) African-American (92) Hispanic (43) Severe injuries resulting in hospitalization Long-bone fracture Heins 20 (2004) Musculoskeletal pain NR, not reported. White (179) African-American (104) Hispanic (103) White (81) African-American (133) Hispanic (235) Painful disorders White (642) African-American (749) Hispanic (105) Other (145) White (249) African-American (603) 80 83 78 67 72 63 80 70 77 84 72 89 NR NR NR 74 69 77 73 71 73 72 NR NR Received opioids (%) 70 66 63 36 42 25 43 21 35 61 33 50 53 51 43 65 59 66 NR Odds ratio whites: African- Americans =1.8
As is the case with many of the other studies of patients with fracture, NHAMCS data do not reveal an association between race/ethnicity and analgesia provision. For white, African-American, and Hispanic patients with extremity or clavicle fractures, analgesia was provided at statistically similar rates of 67%, 72%, and 63%, respectively. For low-back pain and migraines, however, analysis of NHAMCS identifies heterogeneous treatment. For these diagnoses, analgesia likelihood for African-American and Hispanic patients was lower than the corresponding likelihood for whites, and the difference remained significant even after adjustment for potential confounders. AGE Epidemiologic overview of ED pain treatment 35 Age-related heterogeneity in analgesia provision is a well-known issue. The treatment of pain in older adults can be impacted by age bias. Analgesia provision in geriatric patients is also affected by myriad issues relating to drug interactions and side effects. Geriatric analgesia is, therefore, addressed in detail in another chapter, which covers both the problems and potential solutions to underanalgesia in older patients. <strong>This</strong> chapter’s discussion focuses on contrasts between treatment of children and of adults less than 70 years. Results from five studies that addressed age and pain treatment are summarized in the table. Some studies were limited by small sample sizes, so the estimates about treatment should be interpreted with caution. With that limitation in mind, useful inferences can be drawn from the existing data. NHAMCS information from 1997 to 2000 has been used to examine the relationship between age and analgesic practice in 2828 patients with longbone or clavicle fractures. 10 One of the findings is that, compared with patients younger than 16 years of age, patients aged 16 to 69 are twice as likely to receive opioid analgesics. A similar trend to more analgesia is seen when analysis is restricted to patients with moderate to severe pain; compared with children, adults are approximately 40% more likely to receive analgesics. 11
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Emergency Department Analgesia An E
Page 7 and 8: Contents List of contributors page
Page 9 and 10: Tension-type headache 384 Trigemina
Page 11 and 12: Michel Galinski, MD Attending Physi
Page 13: Benjamin A. White, MD Resident, Har
Page 16 and 17: xiv Foreword code to light up the p
Page 18 and 19: xvi Foreword The authors of the boo
Page 21 and 22: Preface A typical shift in the Emer
Page 23 and 24: Acknowledgments Many thanks to this
Page 25: General considerations
Page 28 and 29: 4 Introduction and general approach
Page 34 and 35: 10 Assessment of pain CATHERINE A.
Page 36 and 37: 12 Assessment of pain n Pain assess
Page 38 and 39: 14 Assessment of pain The Face, Leg
Page 40 and 41: 16 Assessment of pain 3. Silka P, R
Page 42 and 43: 18 Assessment of pain 33. Melzack R
Page 44 and 45: 20 Prehospital analgesia and protoc
Page 46 and 47: 22 Prehospital analgesia prehospita
Page 48 and 49: 24 Prehospital analgesia care provi
Page 50 and 51: 26 Prehospital analgesia EMS settin
Page 52 and 53: 28 Prehospital analgesia 18. Kurtz
Page 54 and 55: 30 Prehospital analgesia 48. Helm M
Page 56 and 57: 32 Epidemiologic overview of ED pai
Page 66 and 67: 42 Geriatric analgesia ULA HWANG AN
Page 68 and 69: 44 Geriatric analgesia physiologic
Page 70 and 71: 46 Geriatric analgesia Analgesic ap
Page 72 and 73: 48 Geriatric analgesia The common e
Page 74 and 75: 50 Geriatric analgesia 12. Hohl C,
Page 76 and 77: 52 Chronic pain DAVID CLINE AND STE
Page 78 and 79: 54 Chronic pain care providers, it
Page 80 and 81: 56 Chronic pain the agent’s monoa
Page 82 and 83: 58 Chronic pain be in the ED record
Page 84 and 85: 60 Chronic pain 7. Freynhagen R, Bu
Page 86 and 87: 62 NSAIDs and opioids applicable sa
Page 88 and 89: 64 NSAIDs and opioids We believe th
Page 90 and 91: 66 NSAIDs and opioids well-demonstr
Page 92 and 93: 68 NSAIDs and opioids 5. Navascues
Page 94 and 95: 70 Nonstandard medication delivery
Page 102 and 103: 78 Reflections on ED analgesia of u
Page 104 and 105: 80 Reflections on ED analgesia para
Page 106 and 107: 82 Reflections on ED analgesia chem
Page 109:
Chief complaints and diagnoses
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88 Abdominal aortic aneurysm occurs
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90 Abdominal aortic aneurysm 19. Le
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92 Aortic dissection Citing sedativ
Page 118 and 119:
94 Arthritis TODD M. LISTWA AND STE
Page 120 and 121:
96 Arthritis NSAIDs may be safer th
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98 Arthritis for patients with high
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100 Arthritis rofecoxib, ordiclofen
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102 Arthritis For breakthrough pain
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104 Arthritis Pediatric: NSAID (e.g
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106 Arthritis 13. Hur C, Chan AT, T
Page 132 and 133:
108 Arthritis 38. Curtis SP, Ko AT,
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110 Arthritis 63. Bliddal H, Tersle
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112 Biliary tract pain A retrospect
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114 Biliary tract pain n Summary an
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116 Biliary tract pain 20. Malesci
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118 Bites and stings - marine enven
Page 144 and 145:
120 Bites and stings - marine jelly
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122 Bites and stings - marine 11. C
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124 Bites and stings - terrestrial
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Page 152 and 153:
Page 154 and 155:
Page 156 and 157:
Page 158 and 159:
134 Breast pain COX-2 selective NSA
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136 Breast pain Pregnancy: acetamin
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138 Burns JEREMY ACKERMAN AND ADAM
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140 Burns for moderate-to-severe bu
Page 166 and 167:
142 Burns References 1. Singer AJM,
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144 Burns 30. Patterson DR, Ptacek
Page 170 and 171:
146 Bursitis and periarticular infl
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Page 174 and 175:
Page 176 and 177:
152 Cancer and tumor pain bony (or
Page 178 and 179:
154 Cancer and tumor pain (20 mg ev
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156 Cancer and tumor pain existing
Page 182 and 183:
158 Cancer and tumor pain n Summary
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160 Cancer and tumor pain 21. Carac
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162 Cardiac chest pain KALANI OLMST
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164 Cardiac chest pain has traditio
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166 Cardiac chest pain Practice Gui
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168 Chest wall trauma MICHEL GALINS
Page 194 and 195:
170 Chest wall trauma NSAIDs. As is
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172 Chest wall trauma n Summary and
Page 198 and 199:
174 Chest wall trauma 21. Seltzer J
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176 Chronic low-back pain limited t
Page 202 and 203:
178 Chronic low-back pain n Summary
Page 204 and 205:
180 Cluster headache SOHAN PAREKH A
Page 206 and 207:
182 Cluster headache n Summary and
Page 208 and 209:
184 Corneal abrasion LISA CALDER n
Page 210 and 211:
186 Corneal abrasion 6. Patrone G,
Page 212 and 213:
188 Cystitis, urethritis, and prost
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Page 216 and 217:
Page 218 and 219:
194 Dysmenorrhea to that achieved w
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196 Dysmenorrhea 12. Fine PG. The r
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198 Endometriosis by 50-74% compare
Page 224 and 225:
200 Esophageal spasm KALANI OLMSTED
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202 Esophageal spasm via central mo
Page 228 and 229:
204 Fibromyalgia MICHAEL WALTA AND
Page 230 and 231:
206 Fibromyalgia A multicenter plac
Page 232 and 233:
208 Fibromyalgia n Summary and reco
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210 Fibromyalgia 15. Sayar K, Aksu
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212 Fibromyalgia 41. Russell IJ, Mi
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214 Gastritis and peptic ulcer dise
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Page 242 and 243:
Page 244 and 245:
Page 246 and 247:
Page 248 and 249:
Page 250 and 251:
226 Gastroesophageal reflux disease
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Page 254 and 255:
Page 256 and 257:
232 Hemorrhoids and perianal pain B
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234 Hemorrhoids and perianal pain a
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236 Hemorrhoids and perianal pain t
Page 262 and 263:
238 Hemorrhoids and perianal pain C
Page 264 and 265:
240 Hemorrhoids and perianal pain 9
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242 Hemorrhoids and perianal pain 3
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244 Migraine and undifferentiated h
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Page 272 and 273:
Page 274 and 275:
Page 276 and 277:
Page 278 and 279:
254 Mucositis and stomatitis KELLY
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256 Mucositis and stomatitis eviden
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258 Mucositis and stomatitis above)
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260 Mucositis and stomatitis 5. Dem
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262 Mucositis and stomatitis 30. Mu
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264 Neck and back pain - mechanical
Page 290 and 291:
266 Neck and back pain - mechanical
Page 292 and 293:
268 Neck and back pain - radicular
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Page 296 and 297:
Page 298 and 299:
274 Neck and back pain - spinal spo
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276 Neck and back pain - spinal spo
Page 302 and 303:
278 Neuropathy - complex regional p
Page 304 and 305:
280 Neuropathy - diabetic DAVID CLI
Page 306 and 307:
282 Neuropathy - diabetic n Summary
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284 Neuropathy - diabetic 16. Lesse
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286 Neuropathy - HIV related 3600 m
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288 Neuropathy - HIV related 12. Le
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290 Neuropathy - overview OVER-THE-
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292 Neuropathy - overview The TCAs,
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294 Neuropathy - overview Gabapenti
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296 Neuropathy - overview However,
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298 Neuropathy - overview Reference
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300 Neuropathy - overview 27. Wiffe
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302 Neuropathy - phantom limb pain
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304 Neuropathy - phantom limb pain
Page 330 and 331:
306 Ocular inflammation STEPHEN H.
Page 332 and 333:
308 Ocular inflammation Other RCT d
Page 334 and 335:
310 Ocular inflammation Pregnancy:
Page 336 and 337:
312 Ocular inflammation 20. Frucht-
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314 Odontalgia MICHAEL T. SCHULTZ A
Page 340 and 341:
316 Odontalgia 100 mg caffeine and
Page 342 and 343:
318 Odontalgia TOPICAL THERAPY Topi
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320 Odontalgia 4. Cooper SA, Engel
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322 Odontalgia 32. Sveen OB, Yaekel
Page 348 and 349:
324 Orthopedic extremity trauma inf
Page 350 and 351:
326 Orthopedic extremity trauma The
Page 352 and 353:
328 Orthopedic extremity trauma fem
Page 354 and 355:
330 Orthopedic extremity trauma 35.
Page 356 and 357:
332 Osteoporotic vertebral compress
Page 358 and 359:
334 Osteoporotic vertebral compress
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336 Otitis media and externa benefi
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338 Otitis media and externa 5. Var
Page 364 and 365:
340 Pancreatitis (which lacks effec
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342 Pancreatitis 5. Hubbard GP, Wol
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344 Pharyngitis KELLY YOUNG n Agent
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346 Pharyngitis complete pain relie
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348 Pharyngitis 7. Blagden M, Chris
Page 374 and 375:
350 Pharyngitis 31. Shi Y, Gu R, Li
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352 Postdural puncture headache Cas
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354 Post-herpetic neuralgia JEREMY
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356 Post-herpetic neuralgia virtual
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358 Post-herpetic neuralgia 11. Raj
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360 Renal colic scores. 3 The Cochr
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362 Renal colic References 1. O’C
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364 Sialolithiasis n Summary and re
Page 390 and 391:
366 Sickle cell crisis concluded th
Page 392 and 393:
368 Sickle cell crisis One potentia
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370 Sickle cell crisis titrated in
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372 Sickle cell crisis but acute ca
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374 Sickle cell crisis treatment ti
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376 Sickle cell crisis 3. Dunlop RJ
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378 Sickle cell crisis Disease-rela
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380 Temporomandibular disorders NAT
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382 Temporomandibular disorders n S
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384 Tension-type headache SOHAN PAR
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386 Tension-type headache for TH, b
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388 Tension-type headache 18. Lance
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390 Trigeminal neuralgia as the ini
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392 Undifferentiated abdominal pain
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Tables
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Selected nonsteroidal anti-inflamma
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Selected opioids Maintenance pediat
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Other analgesic drugs Lactation Dos
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Other analgesic drugs (cont.) Lacta
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Other analgesic drugs (cont.) Lacta
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