Pain Management in the Emergency Patient
In the emergency room, pain is often the item deferred with "let's stabilise first, we'll deal with it after". Yet untreated pain is not merely a comfort issue: it produces tachycardia, hypertension, increased oxygen consumption, immune suppression and delayed healing. Treating pain is therefore part of stabilisation, not a luxury that follows it.
Measure first: "doesn't look painful" is not data
Animals conceal pain, cats especially. A patient sitting quietly is not comfortable; more often it is withdrawn.
The answer is to use validated pain scales. Scales developed for dogs and cats that can be applied quickly in practice are available (the short form of the Glasgow composite measure and the Colorado scales are widely used). These scales:
- Make assessment independent of the observer
- Establish a shared language within the team
- Make post-treatment reassessment meaningful
A practical rule: record the pain score as a routine parameter, alongside temperature and heart rate. What is not measured is not managed.
Facial expression-based assessment in cats (ear position, orbital tightening, muzzle and whisker tension) is particularly valuable; it catches the silent cat.
Multimodal analgesia: one drug rarely does the job
Pain is not transmitted by a single pathway. Combining drugs that act at different points lowers the dose of each while increasing the total effect, and reduces the risk of side effects along the way.
The components combined in practice:
- Opioids — the cornerstone in acute severe pain
- Local and regional blocks — the component with the most value and the least use
- NSAIDs — in the right patient, at the right time
- Adjuncts — infusions such as ketamine and lidocaine
Opioids: first line in the emergency patient
In acute trauma, fractures, acute abdomen and postoperative pain, opioids are the first choice. Their relative cardiovascular safety is the decisive advantage in a haemodynamically fragile patient.