Overview:

Do you ever get overwhelmed with all the ED analgesic options? In part 2 of our series on ED Pain Management, Dr. Sergey Motov of Maimonides Medical Center helps break things down, reviewing a few cases and finishing with Sergey’s 10 Commandments of ED Pain Management.

Key Points:
Sergey's 10 Commandments of ED Pain Management

1. Titrate opioids regardless of initial dosing regimen: weight-based, fixed, or nurse-initiated.
2. Use alternatives (to IV) routes of analgesic administration: PO, PR, IN, SubQ, nebulized, topical.
3. Utilize sub-dissociative dose ketamine for selected acute and chronic painful conditions.
4. Educate patients about appropriate expectations of pain course and management.
5. Embrace a concept of channels/enzymes/receptors targeted analgesia.
6. Use NSAIDs based on their analgesic ceiling dose.
7. Attempt to use non-opioid analgesics whenever possible.
8. Promote nerve blocks for a variety of acute painful conditions (trauma, infection, inflammation).
9. DO NOT prescribe long-acting opioids, SR/ER opioids, or fentanyl patches in the ED or at discharge.
10. If indicated, DO prescribe a short course of immediate release opioids (preferably morphine sulfate IR) at discharge and arrange proper follow-up.

Resources and References:

1. Cisewski DH, Motov SM. EMRA Pain Management Guide. EMRA. Dallas, Texas:2020. 
   • App version available within MobilEM at iTunes and Google Play.

2. Motov SM. PainFreeED.com.