Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · May 2005
ReviewComplementary and alternative pain therapy in the emergency department.
One primary reason patients go to emergency departments is for pain relief. Understanding the physiologic dynamics of pain, pharmacologic methods for treatment of pain, as well CAM therapies used in treatment of pain is important to all providers in emergency care. Asking patients about self-care and treatments used outside of the emergency department is an important part of the patient history. ⋯ Adding nondrug therapies of physical therapy, cognitive-behavioral therapy, TENS, hypnosis, biofeedback, psychoanalysis, and others can complete the conventional picture. Adding in simple mind/body therapies, touch therapies, acupuncture, or others may be appropriate in select cases, and depending on the circumstances, may effect and enhance a conventional pain management program. Armed with an understanding of pain dynamics and treatments, practitioners can better meet patient needs, avoid serious side effects, and improve care when addressing pain management in the emergency department.
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Emerg. Med. Clin. North Am. · May 2005
ReviewEstablishing an emergency department pain management system.
Any ED system for the management of pain in the ED should consider the following: assessment of pain including mandatory use of some assessment tool, a guideline for treatment of pain, communication with other members of the health care team, assessment tools, program monitoring, and a continuous quality assurance program. The treatment guideline should consider acute versus chronic pain, potential medication tolerance, concurrent anxiety and psychiatric issues, special populations, and disease-specific conditions.
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Drug-seeking patients include recreational drug abusers, addicts whose dependence occurred through abuse or the injudicious prescription of narcotics, and pseudoaddicts who have chronic pain that has not been appropriately managed. Opioids produce euphoria in some patients, providing the motivation for abuse, which can be detrimental even with occasional use. ⋯ For many patients, drug-seekers and chronic pain patients alike, withholding opioids may be an important part of their long-term management. For others, long-acting opioids such as long-acting morphine or methadone are a reasonable option.
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Emerg. Med. Clin. North Am. · May 2005
ReviewPain assessment instruments for use in the emergency department.
Each patient's pain experience is uniquely his or her own. Standardized pain assessment methodologies and procedures provide a window to this experience and constitute a necessary first step to our understanding of pain, in both clinical and research settings. ⋯ This article provides information on a number of assessment techniques that are appropriate for clinical and research use. Their use should inform our practice and lead to continuous improvements in our management of pain.
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Emerg. Med. Clin. North Am. · May 2005
ReviewLegal issues in pain management: striking the balance.
The momentum over the past several years resulting in positive change to state pain policy is encouraging, especially as the medical community meets greater expectations from patients for appropriate pain management. As the trend for increased medical use of opioid medications continue it is important that medical professionals continue to work with government officials to ensure efforts to curb drug abuse do not impede patient access to pain management. ⋯ In 2004, the Mayday Project at ASLME will host a national conference, with an emphasis on pain management in the emergency department. The previous noted success of Mayday Project activities should give all of us hope that through scholarly activity further guidance will be provided in finding that critical balance between effective pain management and drug diversion.