Pain Management
PAIN MANAGEMENT IN THE EMERGENCY MEDICINE DEPARTMENT
Associate Professor Peter Manning Emeritus Consultant Emergency Medicine Department National University Hospital, Singapore
Jan 2004
Revised Aug 07 / Feb 08 / Nov 09 / Dec 11 / Dec 12
Accepted practice patterns must be questioned – implementation of pain score to vital signs
We underestimate the pain produced by common practical procedures
Analogy – just as we vary antibiotics according to sensitivities, perhaps we should be prepared to be more flexible with our pain management
We will discuss:
1.Management of acute pain in the EMD emphasizing various clinical scenarios 2.Procedural sedation (a.k.a conscious
sedation) 3. Management of chronic pain in the EMD
“OLIGOANALGESIA”
(Wilson JE, Pendleton JM. Oligoanalgesia in the
Emergency Department. Am J Emerg Med 1989;7620-623) “OPIOPHOBIA” [Sergey M. Motov & John P. Marshall. Acute Pain Management Curriculum for Emergency Medicine Residency Programs. Academic Emergency medicine 2011; 18:S87-S91]
Why is this so when we see plenty of people in pain? – it is, after all, the commonest presenting symptom at the
EMD!
?
Early and appropriate management of pain is important because : • patients become increasingly more sensitive to painful stimulus the longer the pain is uncontrolled – a process called “wind-up” • interventions before “wind-up” occurs can potentially decrease subsequent pain and analgesic requirements
• incomplete pain relief should be the choice of the patient, not the physician
“Whose pain is it anyway?”
Pain is a major cause of partial or total disability in industry – it has astonishing economic implications in terms of healthcare utilization and lost wages
How would you manage
PAIN in the following conditions that are frequently encountered in the ED ?
Scenario 1
Scenario 2
Scenario 3
Scenario 4
Scenario 5
Scenario 6
Scenario 7
Scenario 8
Scenario 9
Associate Professor Peter Manning Emeritus Consultant Emergency Medicine Department National University Hospital, Singapore
Jan 2004
Revised Aug 07 / Feb 08 / Nov 09 / Dec 11 / Dec 12
Accepted practice patterns must be questioned – implementation of pain score to vital signs
We underestimate the pain produced by common practical procedures
Analogy – just as we vary antibiotics according to sensitivities, perhaps we should be prepared to be more flexible with our pain management
We will discuss:
1.Management of acute pain in the EMD emphasizing various clinical scenarios 2.Procedural sedation (a.k.a conscious
sedation) 3. Management of chronic pain in the EMD
“OLIGOANALGESIA”
(Wilson JE, Pendleton JM. Oligoanalgesia in the
Emergency Department. Am J Emerg Med 1989;7620-623) “OPIOPHOBIA” [Sergey M. Motov & John P. Marshall. Acute Pain Management Curriculum for Emergency Medicine Residency Programs. Academic Emergency medicine 2011; 18:S87-S91]
Why is this so when we see plenty of people in pain? – it is, after all, the commonest presenting symptom at the
EMD!
?
Early and appropriate management of pain is important because : • patients become increasingly more sensitive to painful stimulus the longer the pain is uncontrolled – a process called “wind-up” • interventions before “wind-up” occurs can potentially decrease subsequent pain and analgesic requirements
• incomplete pain relief should be the choice of the patient, not the physician
“Whose pain is it anyway?”
Pain is a major cause of partial or total disability in industry – it has astonishing economic implications in terms of healthcare utilization and lost wages
How would you manage
PAIN in the following conditions that are frequently encountered in the ED ?
Scenario 1
Scenario 2
Scenario 3
Scenario 4
Scenario 5
Scenario 6
Scenario 7
Scenario 8
Scenario 9