Multimodal Pain Management in Emergency Medicine: A Narrative Review.

Pain is one of the most common reasons for presentation to the emergency department, yet it remains frequently undertreated despite effective therapies. Emergency physicians must provide timely analgesia while accounting for diagnostic uncertainty, patient heterogeneity, and safety concerns, particularly related to opioid use. This narrative review synthesizes contemporary evidence on multimodal pain management in emergency medicine. A focused literature search of PubMed and Scopus was conducted to identify studies published between 2015 and 2025, as well as selected landmark studies and major clinical guidelines. Multimodal analgesia, combining pharmacological and non-pharmacological strategies targeting different pain pathways, is associated with improved pain control and reduced opioid use in emergency settings. Key elements include early pain assessment, timely initiation of therapy, opioid-sparing approaches, and use of non-opioid analgesics, low-dose ketamine, and regional anesthesia. Implementation remains inconsistent due to operational constraints such as overcrowding, workflow pressures, and variability in clinician experience. A structured, patient-centered multimodal approach may improve pain control and support safer, more consistent analgesic care in emergency medicine.