Emergency Department Pain Management: Beyond Opioids -

Emergency Department Pain Management: Beyond Opioids
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Publication Date: November 2019 (Volume 21, Number 11)

No CME for this activity


Abdulaziz Almehlisi, MBBS
Assistant Professor, Department of Emergency Medicine, King Saud University, Riyadh, Saudi Arabia
Christopher Tainter, MD, RDMS
Associate Clinical Professor, Department of Anesthesiology, Division of Critical Care and Department of Emergency Medicine University of California-San Diego, San Diego, CA

Peer Reviewers

Associate Professor, Director of Clinical Quality Review, Emergency Medicine Residency, Icahn School of Medicine at Mount Sinai, New York, NY
Christopher Hahn, MD
Associate Residency Director, Department of Emergency Medicine, Mount Sinai St. Luke’s-West; Assistant Professor, Icahn School of Medicine at Mount Sinai, New York, NY


Pain is a common factor in many emergency department visits. While opioids remain a mainstay of treatment for many patients, prescription-opioid overuse and misuse have become epidemic in the United States. A lack of clear understanding of the pain management options available contributes to this problem, resulting in opioid overuse and over-prescription. National guidelines and consensus statements emphasize the importance of knowing nonopioid pharmacological and nonpharmacological options for treating patients with acute pain. This evidence-based review summarizes the pathophysiology of pain and pain syndromes and provides recommendations for a variety of nonopioid treatment options.

Excerpt From This Issue

A 73-year-old woman with a history of peptic ulcer disease and stage 3 chronic kidney disease presents to the ED after “twisting” her ankle. She tried acetaminophen at home, but it didn’t adequately alleviate her pain. Currently, she complains of 6/10 pain at rest. She has mild swelling and tenderness at the posterior edge of her lateral malleolus. You order an ankle x-ray to evaluate for fracture and consider giving her oxycodone, but you wonder whether there is a better and safer alternative…

While you are waiting for the x-ray, a 42-year-old woman with a history of chronic lymphoma-associated back pain presents with an exacerbation of her back pain. She denies recent trauma, weight loss, paresthesia or weakness, and bowel or bladder incontinence or retention, and she tells you this pain is similar to her usual pain. She mentions that she was robbed today, and her pain medication (oxycodone) was stolen, and she asks for a refill. She states that since it is a weekend, her primary care doctor’s office is closed. The ED is packed, and you are tempted to simply refill the prescription, but you wonder whether there is a better option…

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