acute pain
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Etiology
- surgery
- trauma
- dental work
- labor & delivery, childbirth
Pathology
- serves as a warning of disease or a threat to the body
Clinical manifestations
- acute pain begins suddenly & is usually sharp in quality
- may be mild & last just a moment
- may be severe & last for weeks or months
- in most cases, acute pain does not last longer than 6 months
- acute pain disappears when the underlying cause of pain has been treated or has healed
Complications
- unrelieved acute pain, may lead to chronic pain.
Management
- use of pain ladder recommended
- acetaminophen
- acetaminophen noninferior to diclofenac alone or to diclofenac plus acetaminophen in reducing acute minor musculoskeletal pain[9]
- acetaminophen better than NSAID or NSAID-acetaminophen combination in reducing acute traumatic extremity pain [11[
- NSAIDs
- combination of NSAIDs & opiates more effective than either alone[2]
- ibuprofen & opioids similarly effective for short-term relief of acute extremity pain when combined with acetaminophen[8]
- use short-acting opiates for acute pain
- avoid use of short-acting opiates for > 3 days for acute nontraumatic pain unrelated to surgery[6]
- avoid long-acting opiates including transdermal fentanyl[10]
- parenteral opiates
- standard dose of morphine (0.1 mg/kg IV)
- inadequate to treat severe pain in Emergency department[1]
- adverse effects of opiate administration rare[1]
- avoid meperidine
- hydromorphone 2 mg IV may work better for adults[3]
- standard dose of morphine (0.1 mg/kg IV)
- subdissociative-dose IV ketamine (0.3 mg/kg)[4]
- intranasal or nebulized ketamine may be an option for treatment of acute pain in elderly[13]
- acupuncture may reduce pain in the emergency department more effectively (92% vs 78%), faster (16 vs 28 minutes) & more safely than morphine (minor adverse effects 3% vs 57%)*[7]
- avoid coadministration of opioids with other CNS depressants
- when switching opioids, lower the dose of the new opioid by at least 25-50% of the calculated equianalgesic dose to account for inter-patient variability in response to opioids[10]
- at hospital discharge, inquire about existing opioids at home[10]
- also see pain
* commentator not enthused about effectiveness of acupuncture, but noted that in midst of an opioid epidemic, we should be open to alternatives[7]
More general terms
More specific terms
References
- ↑ 1.0 1.1 1.2 Bijur PE et al Intravenous morphine at 0.1 mg/kg is not effective for controlling severe acute pain in the majority of patients Ann Emerg Med 2005; 46:362 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16187470
- ↑ 2.0 2.1 Ong CK et al Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: A qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg 2010 Apr; 110:1170. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20142348
- ↑ 3.0 3.1 Chang AK et al. Randomized clinical trial of efficacy and safety of a single 2-mg intravenous dose of hydromorphone versus usual care in the management of acute pain. Acad Emerg Med 2013 Feb; 20:185 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23406078
- ↑ 4.0 4.1 Motov S et al. Intravenous subdissociative-dose ketamine versus morphine for analgesia in the emergency department: A randomized controlled trial. Ann Emerg Med 2015 Mar 26 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25817884
- ↑ WebMD: pain management guide http://www.webmd.com/pain-management/guide/pain-basics
- ↑ 6.0 6.1 Centers for Disease Control and Prevention (CDC) Proposed 2016 Guideline for Prescribing Opioids for Chronic Pain. Federal Register. Dec 14, 2015 https://www.federalregister.gov/articles/2015/12/14/2015-31375/proposed-2016-guideline-for-prescribing-opioids-for-chronic-pain
Draft CDC Guideline for Prescribing Opioids for Chronic Pain
United States, 2016 http://www.regulations.gov/#!documentDetail;D=CDC-2015-0112-0002 - ↑ 7.0 7.1 7.2 Pallin DJ Acupuncture vs. Morphine for Emergency Department Patients with Pain. Physician's First Watch, Aug 2, 2016 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
Grissa MH et al. Acupuncture vs intravenous morphine in the management of acute pain in the ED. Am J Emerg Med 2016 Jul 20; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27475042 - ↑ 8.0 8.1 Chang AK, Bijur PE, Esses D et al Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department. A Randomized Clinical Trial. JAMA. 2017;318(17):1661-1667 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29114833 https://jamanetwork.com/journals/jama/article-abstract/2661581
Kyriacou DN Opioid vs Nonopioid Acute Pain Management in the Emergency Department. JAMA. 2017;318(17):1655-1656 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29114813 https://jamanetwork.com/journals/jama/article-abstract/2661559 - ↑ 9.0 9.1 Ridderikhof ML, Lirk P, Goddijn H et al. Acetaminophen or nonsteroidal anti-inflammatory drugs in acute musculoskeletal trauma: A multicenter, double-blind, randomized, clinical trial. Ann Emerg Med 2017 Oct 13 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29033294 <Internet> http://www.annemergmed.com/article/S0196-0644(17)31506-8/fulltext
- ↑ 10.0 10.1 10.2 10.3 10.4 Herzig SJ, Mosher HJ, Calcaterra SL et al Improving the Safety of Opioid Use for Acute Noncancer Pain in Hospitalized Adults: A Consensus Statement From the Society of Hospital Medicine. J. Hosp. Med. 2018 April;13(4):263-271 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29624189 https://www.journalofhospitalmedicine.com/jhospmed/article/161927/hospital-medicine/improving-safety-opioid-use-acute-noncancer-pain
Herzig SJ, Calcaterra SL, Mosher HJ Safe Opioid Prescribing for Acute Noncancer Pain in Hospitalized Adults: A Systematic Review of Existing Guidelines. J Hosp Med. 2018 Apr;13(4):256-262. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29624188 - ↑ Msolli MA, Sekma A, Toumia M et al. Acetaminophen, nonsteroidal anti-inflammatory drugs, or combination of both analgesics in acute posttrauma pain: A randomized controlled trial. Acad Emerg Med 2020 Nov 3 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33145862 https://onlinelibrary.wiley.com/doi/10.1111/acem.14169
- ↑ Guidelines on the assessment and management of acute pain Institute for Clinical Systems Improvement (ICSI) http://www.icsi.org/knowledge/browse_bydate.asp?catID=29
- ↑ 13.0 13.1 Almodibeg B, Forget P Challenges of acute pain management in older patients. Age Ageing. 2024 Apr 1;53(4):afae061. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38557666 https://academic.oup.com/ageing/article/53/4/afae061/7638303