Non-Opioid Pharmaceutical Alternatives for Acute Pain Management in the Emergency Department: A Scoping Review.

OBJECTIVES

In light of the ongoing opioid epidemic, emergency clinicians have faced the difficult challenge of managing acute pain while reducing opioid prescriptions. Improved use of non-opioid analgesics could decrease the need for opioid medications in the management of acute pain. Limited work has been done to systematically produce a comprehensive list of non-opioid pharmaceuticals targeted to specific pain-associated conditions.

METHODS

We conducted a scoping review of recent literature for non-opioid pharmaceuticals that could help manage five painful conditions commonly treated in our institution's ED: abdominal pain; back pain; chest pain; fracture pain; and headache. In November 2023, we identified reviews published from November 2018-2023 in PubMed to curate a list of alternatives to opioids to effectively manage acute pain.

RESULTS

We screened 246 studies that reviewed management approaches for the five chosen conditions that commonly present with pain in the ED and included 23 studies. Acetaminophen and nonsteroidal anti-inflammatory drugs were recommended for all five painful conditions. Ketamine was suggested for abdominal pain, chest pain, and headaches. For back pain, anti-depressants and muscle relaxants were advised. Benzodiazepines and anti-psychotics were indicated for abdominal pain. Triptans, anti-psychotics, and anti-emetics were suggested for headaches.

CONCLUSION

This review highlights several non-opioid medications for treating acute pain in the ED. The targeted, comprehensive list generated in this study can serve as a practical resource to support alternative-to-opioid programs in EDs by guiding the creation of pharmaceutical order sets tailored to common ED presentations. Ultimately, this tool may help reduce unnecessary opioid exposure and improve patient outcomes in emergency care settings.