Analgesia Anaesthesia section
Mx source of pain
Management of Injuries
Pain Score in isolation is NOT useful.
Need also to consider findings of catecholamine surge:
Raised BP, HR, RR, Sweating, Flushed, Nausea.
Distress is distress, perhaps (not always) secondary to pain.
Treat distress with appropriate small doses of anxiolytics and you will lower your analgesic requirement.
BUT… anxiolytics themselves are NOT a treatment for pain!
Different types of pain required different approaches:
Try to working out where the pain is coming from.
stablish an Analgesia Base
NSAID (if not contraindicated) for all
Manage the Source of pain
Nociceptive Pain (i.e. Normal pain associated with acute injury/insult)
Epigastric Pain: PPI or H2 Receptor Antagonist (i.e.
Zoton Fastab MADE IN IRELAND) Cramping Pain: Hyoscine Butylbromide (Buscopam)
Is the patient constipated? (Movicol, Microlette, etc.)
Inflammatory Pain: (NSAIDs, or Steroids) ± Antihistamine
Bone / Muscle Pain: i.e. acute injury – see separate section
Nausea and Vomiting/ Retching Pain: NG tube ± Anti emetics
Neuropathic Pain (i.e. Chronic, abnormal processing of sensory input)
For chronic, please see
Neuropathic Pain page Assessment is important: Is this new pain because the patient is constipated? Gastritis? Injured?
Antidepressant and Anti-epileptics have role (has the patient recently stopped them?)
Is the patient still taking their Paracetamol + NSAID (i.e. baseline).
Better for the patient to be given Breakthrough pain relief and to see Pain Team in elective setting for objectivity.
When to reach for Strong Opiates (Morphine preparations)
In Acute Visceral Pain
ONLY once all of the above options have been utilised
Titrate to response
Managing Injuries in the ED
Decide how you are going to TREAT the pain!
Reduce, Splint, Cover or Irrigate? Analgesia Base
NSAID +- Simple opioid (codeine NOT Morphine). Procedural Analgesia and Sedation
- See separate Sedation Policies for Adults and Children
- Short acting opiates such as Fentanyl for the procedure itself ±
- Short acting Hypnotic (e.g. See policy) or
Regional Anaesthetic technique.
Treat the pain
Burns: Cover from air.
Post Treatment Options:
Maintain Analgesia Base.
Consider Codeine/Paracetamol preparations (Solpadine 8/500 or Solpadol 30/500).
Going to theatre/in-patient: Consider Long acting Opiate (Morphine).
Content by Dr Jason Van Der Veldt 03/11/2010. Last review
Dr Íomhar O' Sullivan 5/05/15