This article is based on previously conducted studies and does not involve any new studies of human or animal subjects performed by any of the authors. Our purpose is to review historical trends and emerging approaches to ED analgesia, with a particular focus on the USA and Canada. In this paper, we present a qualitative review of past and current descriptive studies of ED pain practice, as well as clinical trials of emerging pain treatment modalities. The reasons for these cross-national consumption disparities are no doubt complex, related to multiple cultural and pharmaceutical marketing differences, and beyond the scope of this review. Recent studies of prescription opioid misuse and abuse in Canada and Australia suggest increasing levels of harm while countries of the European Union report disparate rates of prescription opioid abuse. Importantly, the USA ranks number one in the consumption of prescription opioids globally, with a per capita consumption rate two to three times that of European countries. As of 2015, this volume had decreased to 640 MME per capita, but remained three times higher than levels in 1999. US opioid prescribing peaked in 2010 at 782 morphine milligram equivalents (MME) per capita. The opioid-centric nature of this change in practice soon became apparent, as the number of opioids prescribed by all healthcare providers increased dramatically over the following decade. Īs a consequence of these efforts, and in part due to industry marketing, pharmacologic approaches to pain treatment (particularly the use of opioids) became more aggressive.

Educational campaigns to promote pain treatment became widespread throughout the healthcare system and, in particular, an increased emphasis on standardized pain assessment was promulgated by the Joint Commission on the Accreditation of Healthcare Organizations, soon to be renamed The Joint Commission. A number of efforts to increase awareness of unmet pain treatment needs, both in the ED and other settings, originated in the USA and Canada in the mid-1990s.

Those at risk included the very young, older adults and members of minority ethnic groups. Descriptive studies of ED pain practice began appearing in the 1990s and many of these investigators discovered that specific patient subgroups were at risk for inadequate pain treatment. Pain is the most common reason for seeking emergency department (ED) care and, as a presenting complaint, pain accounts for up to seventy percent of ED visits.

Jennifer weiner nytimes today