Approach to adult patients admitted with pain to the emergency department

Pain is the most common complaint among patients presenting to the emergency department (ED). Acute pain activates the sympathetic system and results in increases in blood pressure, heart rate, and respiratory rate, as well as urinary retention, enlarged pupils, and contraction of local muscles. Inadequate management of acute pain may result in thromboembolic or pulmonary complications, prolonged intensive care unit or regular ward stay, hospital readmission for pain following discharge, reduced quality of life, and the development of chronic pain. Effectively provided analgesia is the single intervention that results in patient satisfaction in the ED. In patients with severe pain, opioids can be directly administered intravenously as potent agents; otherwise, per oral-intramuscular non-steroidal anti-inflammatory drugs or intravenous-per oral paracetamol may be administered. To reduce analgesia-associated complications in patients encountered in the ED, appropriate analgesics should be titrated and used in appropriate doses.