Diverse pain management options for emergency room patients

Emergency Room Pain Relief: What Are Your Options?

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Beau Callahan in Health & Wellness December 2025 • 4 min read.

"Navigating acute pain management in the ER? Discover effective pharmacologic and non-pharmacologic treatments to help you find relief and improve your care."


Emergency departments (EDs) are often the first point of contact for individuals experiencing acute pain. Whether it's a sudden injury, a flare-up of a chronic condition, or an unknown source of discomfort, managing pain effectively in the ER is crucial. The American College of Emergency Physicians (ACEP) recognizes this need and provides guidelines to optimize pain management in the ED, ensuring patients receive prompt, safe, and effective care.

These guidelines emphasize a patient-specific approach, considering individual factors and the nature of the pain. Treatment strategies range from pharmacological interventions, such as non-opioid and opioid medications, to non-pharmacological methods, including communication techniques and physical interventions. The goal is to provide relief while minimizing potential risks and side effects.

This article will explore the ACEP's recommendations for acute pain management in the ED, offering insights into the various treatment options available and how they can be tailored to meet your specific needs. Understanding these approaches can empower you to actively participate in your care and work with healthcare providers to achieve the best possible outcome.

Pharmacologic Treatments: Balancing Relief and Risk

Diverse pain management options for emergency room patients

When it comes to managing acute pain, medications often play a central role. The ACEP guidelines recommend a stepwise approach, starting with non-opioid options whenever possible. This helps to minimize the risk of side effects and potential complications associated with stronger medications.

Here's a breakdown of common pharmacologic treatments used in the ED:

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen and naproxen can effectively reduce pain and inflammation. However, they should be used cautiously in individuals with kidney problems, heart failure, or a history of gastrointestinal bleeding.
  • Acetaminophen: Oral or rectal acetaminophen is a good initial option for mild to moderate pain. Intravenous acetaminophen offers similar benefits but is typically reserved for those who cannot take medication by mouth.
  • Regional Anesthesia (Nerve Blocks): These procedures can provide targeted pain relief by blocking nerve signals in a specific area. Ultrasound guidance can enhance precision and effectiveness.
  • Subdissociative-Dose Ketamine (SDK): SDK may be used alone or with other pain relievers for both traumatic and non-traumatic pain. Patients should be informed about potential transient side effects.
  • Intravenous Lidocaine: This medication can be beneficial for certain conditions like renal colic or acute radicular back pain, but it's not suitable for individuals with structural heart disease or rhythm disturbances.
  • Topical Lidocaine Patches: These patches can provide localized pain relief for conditions like postherpetic neuralgia.
  • Opioid Analgesics: While effective for severe pain or when other treatments fail, opioids carry risks of sedation, respiratory depression, and potential for dependence. Your doctor will assess your individual risk factors and discuss potential side effects before prescribing.
If opioids are deemed necessary, the guidelines recommend using the lowest effective dose for the shortest possible duration. Immediate-release formulations are preferred over extended-release options. Patients should also be counseled on the safe storage and disposal of opioid medications.

Beyond Medications: Exploring Non-Pharmacologic Approaches

Pain management isn't solely about medications. Non-pharmacologic treatments play a vital role in providing holistic and effective care. These approaches can reduce reliance on drugs and empower patients to actively manage their pain.

Effective non-pharmacologic strategies include patient-centered communication, physical interventions (ice, heat, topical coolants), activity and exercise recommendations, and relaxation techniques. Empathy and trust between patient and provider are key to optimizing outcomes.

By understanding both pharmacologic and non-pharmacologic options, you can work collaboratively with your healthcare team to develop a personalized pain management plan that addresses your specific needs and promotes your well-being.

About this Article -

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Everything You Need To Know

1

What are the main approaches to managing acute pain in the emergency room?

In emergency rooms, acute pain is often managed using a combination of pharmacologic and non-pharmacologic treatments, tailored to the individual and the nature of their pain. Pharmacologic options include non-opioid medications like Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen and naproxen, which reduce pain and inflammation, and acetaminophen, available in oral, rectal, or intravenous forms. Regional anesthesia, like nerve blocks, can target specific areas, while subdissociative-dose ketamine (SDK) and intravenous lidocaine may be used in certain situations. Topical lidocaine patches are also an option for localized pain. If necessary, opioid analgesics may be used cautiously for severe pain. Non-pharmacologic treatments complement these medications, reducing reliance on drugs and empowering patients to actively manage their pain.

2

What is the role of the American College of Emergency Physicians (ACEP) in pain management within emergency departments?

The American College of Emergency Physicians (ACEP) provides guidelines for pain management in emergency departments (EDs) that prioritize a patient-specific approach. These guidelines emphasize prompt, safe, and effective care, considering individual factors and the nature of the pain. Treatment strategies range from pharmacological interventions, such as non-opioid and opioid medications, to non-pharmacological methods, including communication techniques and physical interventions. The goal is to provide relief while minimizing potential risks and side effects.

3

When managing acute pain in the ER, what are Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Acetaminophen and what are their limitations?

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) like ibuprofen and naproxen can effectively reduce pain and inflammation. However, they should be used cautiously in individuals with kidney problems, heart failure, or a history of gastrointestinal bleeding. Acetaminophen is another option for mild to moderate pain, available in oral, rectal, or intravenous forms. These are typically the first line of defense before considering options like opioid analgesics due to the risks of sedation, respiratory depression, and potential for dependence. The use of NSAIDs and acetaminophen align with the ACEP guidelines.

4

Why are opioid analgesics used cautiously for pain management, and what guidelines are in place for their use?

Opioid analgesics are used for severe pain or when other treatments have failed, but they carry risks of sedation, respiratory depression, and potential for dependence. Because of these risks, The American College of Emergency Physicians (ACEP) guidelines recommend using the lowest effective dose for the shortest possible duration. Immediate-release formulations are preferred over extended-release options. Patients should also be counseled on the safe storage and disposal of opioid medications. These guidelines help to minimize the potential for adverse effects and dependence.

5

Besides medications, what other non-pharmacologic methods are available for pain management in the ER, and how do they help?

Non-pharmacologic approaches can significantly reduce reliance on medications and empower patients to actively manage their pain. While the specific types of non-pharmacologic methods are not detailed extensively, they could include techniques like communication strategies to help patients better express their pain and understand their treatment options, physical interventions such as applying ice or heat, positioning, massage, or other therapies. The ACEP guidelines support the use of these approaches as part of a holistic treatment plan.

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