The International Association for the Study of Pain defines pain as, “An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”1 Pain is present in up to 70% of emergency department (ED) visits.2 It has profound economic consequences, with losses estimated at $61.2 billion per year in the United States.3 Approximately 34% of ED visits are related to injuries,4 and the majority of these warrant symptomatic management. Therefore, traumatic pain management comprises a large part of emergency care.
There has been a great deal of research performed on pain, although particular areas (eg, acute headache) have more data than others. Consequently, recommendations and discussions are not evenly distributed. Indeed, pain management is such a broad topic that fellowships and entire careers are devoted to its study. Numerous studies suggest that, in general, ED pain management is inadequate.5-9
There are many factors that influence appropriate pain management. Patient factors (type of injury, age, medical history) as well as resource availability, cost, and provider familiarity with different options create a diverse array of practice patterns. There is no obvious “correct” strategy to any particular situation, and it benefits both the patient and provider for the emergency clinician to be familiar with the underlying mechanism and treatment options for such conditions. This issue of Emergency Medicine Practice provides a foundation for the management of acute traumatic pain in the emergency setting. While not intended to be all-inclusive, it will present an evidence-based appraisal of issues related to this topic.