Basic pharmacology and advances in emergency medicine

Pain is the most common reason patients seek care in emergency departments (ED), and emergency physicians treat many patients who have severe pain, ranging from shingles to long bone fractures to myocardial infarction. The volume and severity of pain-related problems make pain management a core skill in emergency medicine, yet there is ongoing evidence that pain is inadequately treated in the ED [1]. When pain is mild, simple analgesics alone may suffice. But the neurophysiology of pain is complex, involving the central and peripheral nervous system at biochemical, neural, cognitive and emotional levels [2,3]. Given the multiple processes, mediators, and receptors responsible for initiating and modulating pain, it is clear that no single agent will provide optimal analgesia in all cases. For more severe pain, it is often necessary to use potent analgesics and analgesic combinations, and it is logical to combine different drugs to capitalize on their complementary mechanisms of action. Multimodal analgesia is a critical concept in pain management, and a practice that emergency physicians use on an hourly basis. Multimodal analgesia may involve diverse methods of pain control (eg, regional block, transcutaneous nerve stimulation, and analgesics) or diverse drug combinations. Acetaminophen, anti-inflammatories, opioids and other adjunctive agents (eg. tricyclics, anticonvulsants, sedating drugs) call be combined in fixed or variable combinations to provide additive or synergistic pain relief without additive side effects. Evidence Suggests that multimodal drug combinations enhance analgesic activity, minimize adverse effects, and enable the use of lower doses of component analgesics (i.e. opioid sparing strategy) [4]. Alternatively,I sustained-release analgesic can be used to manage baseline pain levels in Conjunction with in as-needed analgesic for breakthrough attacks. Fixed-dose combinations like acetaminophen (Tylenol 43) or acetaminophen and oxycodone (Percocet) are widely used and convenient, but offer limited flexibility and may preclude the optimal dosing of component drugs to meet patient needs. Wherever possible. clinicians Should tailor the pharmaceutical cocktail to the nature or the pain and the patient's specific needs, rather than adopting a "one size fits all" approach. To provide optimal pain control for their patients. emergency physicians should have an in-depth understanding of analgesic drugs and how to use and combine them effectively. The purpose or this article is to describe the pharmacology and use of analgesic agents that are most useful in the management of acute pain in the ED.