Inadequate analgesia in emergency medicine

Ann Emerg Med. 2004 Apr;43(4):494-503. doi: 10.1016/j.annemergmed.2003.11.019.


Review of emergency department pain management practices demonstrates pain treatment inconsistency and inadequacy that extends across all demographic groups. This inconsistency and inadequacy appears to stem from a multitude of potentially remediable practical and attitudinal barriers that include (1) a lack of educational emphasis on pain management practices in nursing and medical school curricula and postgraduate training programs; (2) inadequate or nonexistent clinical quality management programs that evaluate pain management; (3) a paucity of rigorous studies of populations with special needs that improve pain management in the emergency department, particularly in geriatric and pediatric patients; (4) clinicians' attitudes toward opioid analgesics that result in inappropriate diagnosis of drug-seeking behavior and inappropriate concern about addiction, even in patients who have obvious acutely painful conditions and request pain relief; (5) inappropriate concerns about the safety of opioids compared with nonsteroidal anti-inflammatory drugs that result in their underuse (opiophobia); (6) unappreciated cultural and sex differences in pain reporting by patients and interpretation of pain reporting by providers; and (7) bias and disbelief of pain reporting according to racial and ethnic stereotyping. This article reviews the literature that describes the prevalence and roots of oligoanalgesia in emergency medicine. It also discusses the regulatory efforts to address the problem and their effect on attitudes within the legal community.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Abdominal Pain / diagnosis
  • Abdominal Pain / drug therapy
  • Acute Disease
  • Adult
  • Aged
  • Analgesia / psychology
  • Analgesics / adverse effects
  • Analgesics / therapeutic use*
  • Attitude of Health Personnel*
  • Child
  • Child, Preschool
  • Chronic Disease
  • Drug and Narcotic Control
  • Emergency Medicine* / education
  • Female
  • Humans
  • Informed Consent
  • Male
  • Mental Competency
  • Pain / drug therapy*
  • Pain / ethnology
  • Practice Patterns, Physicians'*
  • Substance-Related Disorders / psychology
  • United States


  • Analgesics