• Jeffrey T Sakamoto, Heather Burrell Ward, VissociJoao Ricardo NickenigJRNDivision of Emergency Medicine, Duke University Hospital, Durham, NC.Department of Neurosurgery, Duke Global Neurosurgery and Neurology Division, Durham, NC.Duke Global Health Institute, Durham, NC., and Stephanie A Eucker.
• Duke University School of Medicine, Durham, NC.
• Acad Emerg Med. 2018 Aug 1; 25 (8): 940957940-957.

ObjectivesPain is a common complaint in the emergency department (ED). Its management currently depends heavily on pharmacologic treatment, but evidence suggests that nonpharmacologic interventions may be beneficial. The purpose of this systematic review and meta-analysis was to assess whether nonpharmacologic interventions in the ED are effective in reducing pain.MethodsWe conducted a systematic review of the literature on all types of nonpharmacologic interventions in the ED with pain reduction as an outcome. We performed a qualitative summary of all studies meeting inclusion criteria and meta-analysis of randomized controlled studies measuring postintervention changes in pain. Interventions were divided by type into five categories for more focused subanalyses.ResultsFifty-six studies met inclusion criteria for summary analysis. The most studied interventions were acupuncture (10 studies) and physical therapy (six studies). The type of pain most studied was musculoskeletal pain (34 studies). Most (42 studies) reported at least one improved outcome after intervention. Of these, 23 studies reported significantly reduced pain compared to control, 24 studies showed no difference, and nine studies had no control group. Meta-analysis included 22 qualifying randomized controlled trials and had a global standardized mean difference of -0.46 (95% confidence interval = -0.66 to -0.27) in favor of nonpharmacologic interventions for reducing pain.ConclusionNonpharmacologic interventions are often effective in reducing pain in the ED. However, most existing studies are small, warranting further investigation into their use for optimizing ED pain management.© 2018 by the Society for Academic Emergency Medicine.

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