It’s something we all encounter in emergency and prehospital care, probably more than anything else, yet it’s a topic we’ve not given a full episode to… until now!

Up to 70% of prehospital patients and 60–90% of ED attendees report pain, with half of all ED presentations having pain as the primary complaint. That’s millions of patients across Europe every year and we’re not always optimising our approach!

In this episode, we’re diving deep into acute pain management; from understanding the complex biopsychosocial definition of pain, right through to tailored pharmacological and non-pharmacological strategies, plus everything in between.

We’ll be looking at how we define and assess pain and the importance of validating patient experience. Then we’ll work through management options: from paracetamol to ketamine, NSAIDs to regional anaesthesia, and talk through barriers like bias, opiophobia, and the persistent inequalities in analgesic delivery.

We’ll also shine a light on special groups;  from paediatrics to chronic pain patients and those with opioid use concerns, finishing with key takeaways on safe discharge planning.

This one’s about being better at recognising, respecting, and relieving pain. Because pain is an emergency, and we’ve got the tools to do something about it.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

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References

Pain; PHEMcast

Clinical Conversations Podcast; Pain

Management of Acute Pain in Adults in the Emergency Department

Guidelines for thenmanagement of acute pain in emergency situations (EUSEM). 2020

Acute Pain Management Pearls: A Focused Review for the Hospital Clinician. Hyland. Healthcare. 2022

The Revised IASP definition of pain: concepts, challenges, and compromises. Raja. Pain. 2021

Intravenous versus oral paracetamol for acute pain in adults in the emergency department setting: a prospective, double-blind, double-dummy, randomised controlled trial. Furyk. Emerg Med J. 2018

Intravenous versus oral paracetamol in a UK ambulance service: a case control study. Charlton. Br Paramed J. 2020

Oral vs. IV paracetamol for pain control in patients with femur fracture in the emergency department: a practical randomized controlled trial. Frances. Signa Vitae. 2023

Quantifying Drug-seeking Behavior: A Case Control Study. Journal Emerg Med. Gover. 2012

Management of Pain in Adults. RCEM Best Practice Guidelines. 2021

The Overuse of the Emergency Department at a Multidisciplinary Pain Clinic by Patients with Chronic Pain: A Cross-Sectional Study. Felix. Cureus. 2023

Efficacy of Intravenous Lidocaine for Pain Relief in the Emergency Department: A Systematic Review and Meta-Analysis. Front Med. Zhong. 2022

IV paracetamol OR oral paracetamol for the treatment of pain. Jarvis. BestBets. 2023

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