Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · May 2005
ReviewBasic pharmacology and advances in emergency medicine.
To provide optimal pain control for their patients, emergency physicians should have an in-depth understanding of analgesic drugs and how to use and combine them effectively. The purpose of this article is to describe the pharmacology and use of analgesic agents that are most useful in the management of acute pain in the emergency department.
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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
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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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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Chronic nonmalignant pain requires evaluation and treatment different from acute pain. The pathophysiology is different, and there is commonly some degree of psychosocial dysfunction. Opioids tend to be much less effective as analgesics for chronic pain, and may increase the sensitivity to pain when given long-term. ⋯ Consequently, emergency and urgent care physicians should work closely with the patient's pain management specialist or personal physician. Systems should be set up in advance to identify those patients whose frequent use of acute care services for obtaining opioids may be compromising their long-term management, putting themselves at risk for psychological and tolerance-induced adverse effects of frequent opioid use. Opioids may be used in carefully selected patients in consultation with their pain management specialist or personal physician, but care must be exercised not to initiate or exacerbate psychological or tolerance-related complications of chronic pain.