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This journal club was a look at four papers, four ways of treating pain in the ED — from mild to severe — using four approaches a little outside our comfort zone of NSAIDS and opiates.

I began the hour with a quick look at a fifth paper (Chang and Gallagher, Annals of EM 2006, Vol. 48 No 2), previously covered in this blog, about a RCT of patient’s reduction in pain after hydromorphone (dilaudid) vs. morphine. It served as a good introduction to pain assessment tools and I liked the author’s candid writing about factors in physician ordering beyond need — such as perceived price or just the psychological barrier to ordering 10mg of morphine over 1 mg or 2 mg of dilaudid. I also had to point out how great it was to see acknowledgment in print of our practice reality — the mode for initial pain score in this study was 10/10. A good read if you have the time.

I also recommended as background reading the section on Pain Assessment Tools, page 8-11 in the July 2006 edition of EMPractice by Curtis & Morrell.  The sections on pathophysiology of pain and ED pain epidemiology was also recommended.

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