Emergency medicine clinics of North America
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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.
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Pain measurement and relief is complex and should be a priority for prehospital providers and supervisors. The literature continues to prove that we are poor pain relievers, despite the high prevalence of pain in the out-of-hospital patient population. Lack of education and research, along with agent availability, controlled substance regulation, and many myths given credence by health care providers, hinder our ability to achieve adequate pain assessment and treatment in the prehospital setting. ⋯ Nonpharmacologic therapies must also be taught and reinforced as important adjuncts to pain management. Finally, formation of quality improvement pain programs that evaluate patient outcomes and provider practice patterns will help EMS systems understand the pain management process and outline areas for improvement. Only through emphasis on pain education, research, protocol and program monitoring development will the quality of pain assessment and management in the prehospital setting improve.
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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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How have we as a profession, whose number-one goal is to decrease human suffering, made pain control such a poorly discussed issue in training? From day 1 of medical school, pain and suffering need to be discussed. No clinical area should be taught without discussion of this most common and most important symptom. ⋯ Alternatives to medications should be as much a part of our armamentarium as caring and compassion. The future of pain control depends on this paradigm shift.
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Emerg. Med. Clin. North Am. · May 2005
ReviewProcedural sedation and analgesia: a review and new concepts.
Procedural sedation and analgesia has become a commonplace procedure in the ED, certainly falling under the domain of the EP. Every EP should approach PSA as a complex procedure requiring high-level skills and knowledge. Initially, understand that PSA represents a spectrum of goals, from anxiolysis and pain relief to deep sedation. ⋯ It is important for the EP to be involved in hospital policy and guidelines associated with this procedure, and to remain aware of new research in this field. EPs can thereby contribute to quality assurance throughout the medical community by setting a standard in the practice of PSA, as they are not the only practitioners using this procedure. With continued practice and research, expertise in this field will grow measurably.