Complementary and alternative pain therapy in the emergency department

Comprehensive care of patients with pain and the complexities in treating it requires understanding the physiologic dynamics of pain, pharmacologic methods for treatment, as well as other measures available for treatment outside of the emergency department that may be part of the patients self-care and belief system. A brief review of the pathophysiology of pain pathways, a review of pain management principles, and a review of complementary and alternative medicine (CAM) therapies used will be discussed. Using CAM strategies with conventional treatments is becoming increasingly popular among patients. Understanding all treatment modalities will allow the practitioners to better meet the needs of their patients and be aware of potential interactions, which may complicate their medical management in the emergency department. Management of pain in the emergency department is a seemingly simple task, but one that reportedly has been done poorly [1-3]. Very few medical schools have acute pain control as part of a core curriculum. With little formal training it may be assumed that pain control is not a priority. Extensive teaching is not necessarily the answer, but some focused teaching and increased awareness may be what is needed to improve pain management [4]. Pain has a predictable presence in patients, but the management of pain is often a single modality of therapy. Traditionally, a one-shot [sic] approach to pain is the approach in the emergency department. This amounts to intravenous, intramuscular, or oral narcotics as the method of choice for most pain and injection of anesthetic agents for local or regional pain as prevention. The Joint Commission on Accreditation of Hospitals Organizations mandates evaluation, treatment, and assessment of effectiveness of pain treatment. As of 2001, pain assessment has become the fifth vital sign (http://www.jcaho.org./, accessed 1/25/03). With this mandate, treating pain has become a priority of health care providers. It is estimated that its many as 75 million Americans live with chronic pain, and 22% of patients in primary care report poorly controlled pain [5,6]. Pain is it costly national problem in lost workdays, hospitalization, physical therapy, disability, and pharmaceutical cost, as well as litigation costs Surrounding pain. Chronic pain accounts for 21% of all emergency room visits, and Causes 25% of days lost in the workplace [6]. It is the third most common health care problem, behind heart disease and cancer. but disables more individuals than heart disease and cancer put together. Studies indicate that, on average, only 57% of it patient's pain is relieved with the best prescribing practices (Steven Passik, PhD, presentation at APS meeting, March 2002, Baltimore). This remaining 43% then is open to improvement in prescribing or in the absence or it clear Surgical or other invasive option, and presents an opportunity for the application of nonpharmacologic and complementary therapies to provide additional relief. There are a number of key factors to be mindful of in pain management. Pain intensity and quality are important to understanding underlying pathophysiology. Pain syndromes Lire associated with distinct etiologies, and have prognostic and therapeutic implications. Our understanding of pain has recently moved forward With Our increased knowledge of pain neuromodulators and the discovery Of neurobiologic processes of pain.