Treating Pain in the ER: What Are the Options?
LAS VEGAS — A presentation held at the 2016 PAINWeek conference took clinicians through case studies describing the use of novel medications and modalities for pain management in the emergency department.1
The scenarios described in the presentation include patients with renal colic successfully treated with intravenous cardiac lidocaine; a patient with acute lower back pain treated with ibuprofen, acetaminophen, and trigger point dry needling; and a patient with a gluteal abscess treated with nitrous oxide.
Alexis LaPietra, DO, told Clinical Pain Advisor that the drugs most commonly used today in emergency departments are acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids, but that other medications and modalities may actually be more efficacious.
“Clinicians need to know there is a lot more in their toolbox for treating pain than they may think,” she noted. “In the current opioid epidemic, clinicians need to continue to use opioids but in a judicious and responsible manner with a focus on the research and appropriate utilization of alternatives whenever possible.”
Dr LaPietra, Medical Director of Pain Management in the Emergency Department at St. Joseph's Regional Medical Center in New Jersey, spearheaded a program at her facility called ALTO (Alternatives to Opiates Program), in which opioids are avoided whenever possible in favor of alternative protocols, such as targeted non-opioid medications, trigger point injections, nitrous oxide, and ultrasound-guided nerve blocks.
Dr LaPietra told Clinical Pain Advisor that physicians who want to evaluate and prescribe alternatives for pain management should familiarize themselves with current literature and attend conferences such as PAINWeek in order to find out about novel therapies and determine how other practitioners are using them.
“Once a clinician feels they want to implement a new modality or medication into their practice, they should discuss it with administration, show the evidence, and be the physician champion for that particular medication/modality,” she recommended.
Dr LaPietra also suggests joining national organizations and building a rapport with other physicians interested in novel approaches to pain management.
*Lastly, physicians can reach out to the company that makes the device or medication and ask for more information or ask to be put in touch with other clinicians or facilities currently utilizing the item of interest,” said Dr LaPietra.
“That is how I started using nitrous oxide. I reached out to the manufacturer and was given a list of facilities using the device. After speaking with individual practitioners about their experience, I started doing my own research into it.”
- Alexis LaPietra, DO. New treatment options for managing pain in the emergency department. Presented at PainWeek 2016; Las Vegas, NV: September 6-10, 2016.