Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-6bf8c574d5-zc66z Total loading time: 0 Render date: 2025-03-09T15:24:58.153Z Has data issue: false hasContentIssue false

8 - Pharmacology of Commonly Utilized Analgesic Agents

from SECTION TWO - ANALGESIA FOR THE EMERGENCY PATIENT

Published online by Cambridge University Press:  03 December 2009

John H. Burton  and
James Miner
By
Eustacia Jo Su
John H. Burton
Affiliation:
Albany Medical College, New York
James Miner
Affiliation:
University of Minnesota
Eustacia Jo Su
Affiliation:
Associate Professor, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, CDW-EM, Portland, OR 97201, Email: [email protected]
Get access

Summary

SCOPE OF THE PROBLEM

Emergency physicians must recognize and treat pain from many causes, from shingles to severe trauma, myocardial infarction to ureterolithiasis. Pain management is an important skill in emergency medicine, requiring recognition and acknowledgment of the patient's pain, adequate treatment, and prompt reevaluation.

Analgesia is the “loss of sensitivity to pain,” or the reduction of pain through therapy. The therapy is not solely pharmacologic in nature: psychological and social support as well as physical positioning for maximum comfort, all help to reduce a patient's perceived pain. Simply reassuring the patient that the provider is aware of the patient's pain and is actively working to relieve the pain can be as important as any medications used.

CLINICAL ASSESSMENT

Approach to the Patient/Situation

It is imperative for physicians to detect and measure pain rapidly so that they can begin treatment promptly and assess its effect. To the physician, the patient may not appear to be in pain, but he or she may actually be in severe pain. Careful listening, observation, and repeated solicitation may be necessary to fully elicit an admission of pain. Assessment must be both qualitative (is pain present?) and quantitative (how much does it hurt? Has it improved with treatment?). Early reassessment must follow any treatments to ensure that it was adequate and without adverse effects, and that repeated doses are given promptly if needed.

Type
Chapter
Information
Emergency Sedation and Pain Management , pp. 43 - 54
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Schug, SA, Sidebotham, DA, McGuinnety, M, et al. Acetaminophen as an adjunct to morphine by patient-controlled analgesia in the management of acute post-operative pain. Anesth Analg 1998;87:368–372.Google Scholar
Barkin, R. Acetaminophen, aspirin or ibuprofen in combination analgesic products. Am J Ther 2001;8:433–442.CrossRefGoogle ScholarPubMed
McEvoy, GK. American hospital formulary service. Bethesda, MD: American Society of Health System Pharmacists, 2000.Google Scholar
Hylek, EM, Heiman, H, Skates, SJ, et al. Acetaminophen and other risk factors for excessive warfarin anticoagulation. JAMA 1998;279:657–662.CrossRefGoogle ScholarPubMed
Lipsky, PE, Brooks, P, Crofford, LJ, et al. Unresolved issues in the role of cyclooxygenase–2 in normal physiologic processes and disease. Arch Intern Med 2000;160: 913–920.CrossRefGoogle ScholarPubMed
Turturro, MA, Paris, PM, Seaberg, DC. Intramuscular ketorolac versus oral ibuprofen in acute musculoskeletal pain. Ann Emerg Med 1995;26:117–120.CrossRefGoogle ScholarPubMed
Loewen, PS. Review of the selective COX-2 inhibitors celecoxib and refocoxib: Focus on clinical aspects. Can J Emerg Med 2002;4:268–275.Google Scholar
Mukherjee, D, Nissen, SE, Topol, E. Risk of cardiovascular events associated with selective COX-2 inhibitors. JAMA 2001;286:954–959.CrossRefGoogle ScholarPubMed
Joranson, , Ryan, KM, Gilson, AM, et al. Trends in medical use and abuse of opioid analgesics. JAMA 2000:283(13): 1710–1714.CrossRefGoogle ScholarPubMed
Jovey RD. Opioid analgesics. In Managing pain, ed. Jovey, RD. Toronto, Canada: Healthcare and Financial Publishing, for the Canadian Pain Society, 2002, pp. 47–61.Google Scholar
Latta, K, Ginsberg, B, Barkin, RL. Meperidine: A critical review. Am J Ther 2002;9:53–68.CrossRefGoogle ScholarPubMed
Weiner, AL. Meperidine as a potential cause of serotonin syndrome in the emergency department. Acad Emerg Med 1999;6:156–158.CrossRefGoogle ScholarPubMed
Quigley, C. Hydromorphone for acute and chronic pain. Cochrane Database Syst Rev 2002;1:CD003447.CrossRefGoogle Scholar
Edwards, JE, Moore, RA, McQuay, JH. Single dose oxycodone and oxycodone plus acetaminophen for acute postoperative pain. Cochrane Database Syst Rev 2000;4: CD002763.Google Scholar
Turturro, MA, Paris, PM, Yealy, DM, et al. Hydrocodone vs codeine in acute musculoskeletal pain. Ann Emerg Med 1991;20:1100–1103.CrossRefGoogle ScholarPubMed
Silverstein, F, Faich, G, Goldstein, J, et al. Gastrointestinal toxicity with celecoxib versus non-steroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritisJAMA 2000;234:1247–1255.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×