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In conclusion, the available evidence on pain treatment shows that the
acute care community has improved in the delivery of pain relief, but that
more improvement is still desirable. Issues regarding class of analgesic, dose,
and adequacy of pain relief as reported by patients must be more fully
explored. Evidence of long waiting times to treatment, suboptimal pain relief,
and high levels of pain on discharge indicate that we are only beginning to
address oligoanalgesia in the ED.
It is not clear that all pain must be relieved, or that the goal of good medical
practice is not reached if some patients indicate incomplete analgesia upon
ED discharge. Even though evolving literature is resolving some debates
about withholding of analgesia (e.g. in patients with abdominal pain), there
remain cases (e.g. hypotensive or head-injured patients) in which administration
of pain medication may incur significant disadvantage. The results of
studies mentioned herein should not be used to brand emergency physicians
as less caring than other healthcare providers. Indeed, the specialty deserves
kudos for focusing a self-reflective (and often critical) eye on ED pain care
practices.
Although it seems hardly likely that any problems with oligoanalgesia are
limited to the ED, emergency physicians are well advised to consider the
components to improving acute care pain relief, as outlined by Todd. 17 In
order to maintain and improve trends in equitable pain relief for all patients
in the ED, leaders and practitioners in EM should advocate for increased
federal funding, integration of acute care providers into the FDA analgesia
review system, and inclusion of pain management curricula in medical
school and residency programs.
References
Epidemiologic overview of ED pain treatment 39
1. McCaig LF, Nawar EW. National Hospital Ambulatory Medical Care Survey:
2004 emergency department summary. Adv Data. 2006(372):1–29.
2. Wilson JE, Pendleton JM. Oligoanalgesia in the emergency department. Am J
Emerg Med. 1989;7:620–623.
3. Selbst S, Clark M. Analgesia use in the emergency department. Ann Emerg Med.
1990;19:1010–1013.