{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T22:44:46Z","timestamp":1783550686368,"version":"3.55.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2003,1,1]],"date-time":"2003-01-01T00:00:00Z","timestamp":1041379200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2003,1,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The question of whether it is safe to provide analgesia for patients with undifferentiated acute abdominal pain is marked by longstanding controversy over the possible masking of physical findings. The goal of this review is to assess the pertinent studies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Method<\/jats:title>\n                  <jats:p>A Medline search was performed in April 2002, using the terms \u2018analgesia\u2019, \u2018abdominal pain\u2019, \u2018acute abdomen\u2019 and \u2018morphine\u2019. Other articles were identified using the bibliographies of papers found through Medline. All articles reporting clinical trials of analgesia and its effects on diagnosis or physical examination were reviewed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of eight trials (one reported only as an abstract) were identified. Because of significant disparity in trial design, no formal analysis such as meta-analysis was performed. However, detailed review of the trials revealed a striking consistency in results. In no study was there an association between analgesia and diagnostic impairment or dangerous masking of the findings of physical examination.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The literature addressing early pain relief for abdominal pain is characterized by weaknesses, but there is a common theme suggesting that analgesia is safe. Pending further research, which should address some of the shortcomings of extant studies, a practice of judicious provision of analgesia appears safe, reasonable and in the best interests of patients in pain.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.4009","type":"journal-article","created":{"date-parts":[[2003,1,14]],"date-time":"2003-01-14T16:16:07Z","timestamp":1042560967000},"page":"5-9","source":"Crossref","is-referenced-by-count":53,"title":["Effect on diagnostic efficiency of analgesia for undifferentiated abdominal pain"],"prefix":"10.1093","volume":"90","author":[{"given":"S H","family":"Thomas","sequence":"first","affiliation":[{"name":"Department of Surgery, Massachusetts General Hospital , Boston, Massachusetts,","place":["USA"]},{"name":"Division of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital , Boston, Massachusetts,","place":["USA"]},{"name":"Department of Emergency Services, Massachusetts General Hospital , Boston, Massachusetts,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W","family":"Silen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Massachusetts General Hospital , Boston, Massachusetts,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2003,1,1]]},"reference":[{"key":"2024093006224823500_bib1","volume-title":"The Early Diagnosis of the Acute Abdomen","author":"Cope","year":"1921"},{"key":"2024093006224823500_bib2","first-page":"424","article-title":"Omission of analgesia in emergency department patients with suspected appendicitis","volume":"4","author":"Thomas","year":"1997","journal-title":"Acad Emerg Med"},{"key":"2024093006224823500_bib3","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/S0735-6757(99)90039-6","article-title":"Informed consent and general surgeons' attitudes toward the use of pain medication in the acute abdomen","volume":"17","author":"Graber","year":"1999","journal-title":"Am J Emerg Med"},{"key":"2024093006224823500_bib4","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/S0736-4679(97)00183-2","article-title":"The use of analgesics in patients with acute abdominal pain","volume":"15","author":"LoVecchio","year":"1997","journal-title":"J Emerg Med"},{"key":"2024093006224823500_bib5","first-page":"424","article-title":"A controlled trial of fentanyl analgesia in emergency department patients with abdominal pain: can treatment obscure the diagnosis?","volume":"4","author":"Garyfallou","year":"1997","journal-title":"Acad Emerg Med"},{"key":"2024093006224823500_bib6","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1111\/j.1553-2712.1996.tb03365.x","article-title":"Intravenous morphine for early pain relief in patients with acute abdominal pain","volume":"3","author":"Pace","year":"1996","journal-title":"Acad Emerg Med"},{"key":"2024093006224823500_bib7","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1136\/bmj.305.6853.554","article-title":"Safety of early pain relief for acute abdominal pain","volume":"305","author":"Attard","year":"1992","journal-title":"BMJ"},{"key":"2024093006224823500_bib8","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1136\/emj.17.2.128-a","article-title":"Towards evidence based emergency medicine: analgesia and assessment of abdominal pain","volume":"17","author":"Mackway-Jones","year":"2000","journal-title":"J Accid Emerg Med"},{"key":"2024093006224823500_bib9","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1148\/radiology.210.3.r99fe54639","article-title":"Acute appendicitis: influence of early pain relief on the accuracy of clinical and US findings in the decision to operate\u2014a randomized trial","volume":"210","author":"Vermeulen","year":"1999","journal-title":"Radiology"},{"key":"2024093006224823500_bib10","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1136\/ewjm.172.3.209","article-title":"Medical myth: analgesia should not be given to patients with an acute abdomen because it obscures the diagnosis","volume":"172","author":"Brewster","year":"2000","journal-title":"West J Med"},{"key":"2024093006224823500_bib11","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/0735-6757(89)90304-5","article-title":"No pain, no pain","volume":"7","author":"Paris","year":"1989","journal-title":"Am J Emerg Med"},{"key":"2024093006224823500_bib12","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1136\/bmj.2.6198.1093","article-title":"Letter. 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