Acute Pain in the Emergency Department: The Challenges

Abstract

• Acute pain is the reason that the majority of patients present to the emergency department. • Failure to adequately treat acute pain in the emergency department has been labelled a public health problem. • The College of Emergency Medicine has set standards for the timelines and adequacy in management of pain in both adults and children. • Joint Care Quality Commission and College of Emergency Medicine national audit demonstrates the gap between standards and current practice. • The new Department of Health clinical quality indicators for emergency medicine do not include a measure of pain. • Untreated pain can have short and long term effects, including sensitisation to pain episodes in later life. • A range of non-pharmacological and pharmacological interventions have been shown to be effective for procedural pain management in infants and children, and are most effective when used in combination. • Developmental changes in pain responses, analgesic response and drug pharmacokinetics need to be taken into account when planning procedural pain management for neonates. • Comprehensive evidence based guidelines are available to guide effective procedural pain management in neonates, infants and older children.