{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T15:37:52Z","timestamp":1771342672860,"version":"3.50.1"},"reference-count":39,"publisher":"Walter de Gruyter GmbH","issue":"4","license":[{"start":{"date-parts":[[2011,10,1]],"date-time":"2011-10-01T00:00:00Z","timestamp":1317427200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_j.sjpain.2011.05.008_s_001\">\n                    <jats:title>Introduction and aim<\/jats:title>\n                    <jats:p>Pain is a frequent symptom in emergency patients and opioids are commonly used to treat it at emergency departments and at pre-hospital settings. The aim of this systematic review is to examine the efficacy and safety of parenteral opioids used for acute pain in emergency medicine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2011.05.008_s_002\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Qualitative review of randomized controlled trials (RCTs) on parenteral opioids for acute pain in adult emergency patients. Main outcome measures were: type and dose of the opioid, analgesic efficacy as compared to either placebo or another opioid and adverse effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2011.05.008_s_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty double-blind RCTs with results on 2322 patients were included. Seven studies were placebo controlled. Majority of studies were performed in the emergency department. Only five studies were in prehospital setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2011.05.008_s_004\">\n                    <jats:title>Prehospital studies<\/jats:title>\n                    <jats:p>Four studies were on mainly trauma-related pain, one ischemic chest pain. One study compared two different doses of morphine in mainly trauma pain showing faster analgesia with the larger dose but no difference at 30 min postdrug. Three other studies on the same pain model showed equal analgesic effects with morphine and other opioids. Alfentanil was more effective than morphine in ischemic chest pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2011.05.008_s_005\">\n                    <jats:title>Emergency department studies<\/jats:title>\n                    <jats:p>Pain models used were acute abdominal pain seven, renal colic four, mixed (mainly abdominal pain) three and trauma pain one study. Five studies compared morphine to placebo in acute abdominal pain and in all studies morphine was more effective than placebo. In four out of five studies on acute abdominal pain morphine did not change diagnostic accuracy, clinical or radiological findings. Most commonly used morphine dose in the emergency department was 0.1 mg\/kg (five studies). Other opioids showed analgesic effect comparable to morphine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2011.05.008_s_006\">\n                    <jats:title>Adverse effects<\/jats:title>\n                    <jats:p>Recording and reporting of adverse effects was very variable. Vital signs were recorded in 15 of the 20 studies (including all prehospital studies). Incidence of adverse effects in the opioid groups was 5\u201338% of the patients in the prehospital setting and 4\u201346% of the patients in the emergency department. Nausea or vomiting was reported in 11\u201325% of the patients given opioids. Study drug was discontinued because of adverse effects five patients (one placebo, two sufentanil, two morphine). Eight studies commented on administration of naloxone for reversal of opioid effects. One patient out of 1266 was given naloxone for drowsiness. Ventilatory depression defined by variable criteria occurred in occurred in 7 out of 756 emergency department patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2011.05.008_s_007\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Evidence for selection of optimal opioid and dose is scarce. Opioids, especially morphine, are effective in relieving acute pain also in emergency medicine patients. Studies so far are small and reporting of adverse effects is very variable. Therefore the safety of different opioids and doses remains to be studied. Also the optimal titration regimens need to be evaluated in future studies. The prevention and treatment of opioid-induced nausea and vomiting is an important clinical consideration that requires further clinical and scientific attention in this patient group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.sjpain.2011.05.008","type":"journal-article","created":{"date-parts":[[2011,9,23]],"date-time":"2011-09-23T14:39:12Z","timestamp":1316788752000},"page":"187-194","source":"Crossref","is-referenced-by-count":9,"title":["Parenteral opioids in emergency medicine \u2013 A systematic review of efficacy and safety"],"prefix":"10.1515","volume":"2","author":[{"given":"Leila","family":"Niemi-Murola","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Medicine , P.O. Box 20 , University of Helsinki , 00014 Helsinki , Finland"},{"name":"Meilahti Hospital, Department of Anaesthesiology and Intensive Care Medicine , P.O. Box 340 , Helsinki University Hospital , 00029 HUS , Helsinki , Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jani","family":"Unkuri","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Medicine , P.O. Box 20 , University of Helsinki , 00014 Helsinki , Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katri","family":"Hamunen","sequence":"additional","affiliation":[{"name":"Meilahti Hospital, Department of Anaesthesiology and Intensive Care Medicine , P.O. Box 340 , Helsinki University Hospital , 00029 HUS , Helsinki , Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2011,10,1]]},"reference":[{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_001","doi-asserted-by":"crossref","unstructured":"Grenman D, Niemi-Murola L, Kalso E. Management of pain in a surgical emergency unit \u2013 underlying factors affecting its\u2019 successful delivery. Acute Pain 2008;10:137\u201344.","DOI":"10.1016\/j.acpain.2008.05.013"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_002","doi-asserted-by":"crossref","unstructured":"Rupp T, Delaney KA. Inadequate analgesia in emergency medicine. Ann Emerg Med 2004;4:494\u2013503.","DOI":"10.1016\/j.annemergmed.2003.11.019"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_003","doi-asserted-by":"crossref","unstructured":"Yanuka M, Soffer D, Halpern P. An interventional study to improve the quality of analgesia in the emergency department. CJEM 2008;10:435\u20139.","DOI":"10.1017\/S1481803500010526"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_004","doi-asserted-by":"crossref","unstructured":"Ricard-Hibon A, Ducasse JL, Ravaud P, Wood C, Viel E, Chauvin M, Brunet F, Bleichner G. Quality control programme for acute pain management in emergency medicine: a national survey. Eur J Emerg Med 2004;11:198\u2013203.","DOI":"10.1097\/01.mej.0000136698.56966.f0"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_005","doi-asserted-by":"crossref","unstructured":"Gaakeer MI, van Lieshout JM, Bierens JJLM. Pain management in the emergency department: a review of present protocols in The Netherlands. Eur J Emerg Med 2010;17:286\u20139.","DOI":"10.1097\/MEJ.0b013e328332114a"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_006","doi-asserted-by":"crossref","unstructured":"Bounes VM, Barniol C, Minville V, Houze-Cerfon CH, Dicasse JL. Predictors of pain relief and adverse events in patients receiving opioids in a prehospital setting. Am J Emerg Med 2010 [Epub ahead of print].","DOI":"10.1016\/j.ajem.2009.12.005"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_007","doi-asserted-by":"crossref","unstructured":"O\u2019Connor AB, Zwemer FL, Hays DP, Changyong F. Intravenous opioid dosing and outcomes in emergency patients: a prospective cohort analysis. Am J Emerg Med 2010;28:1041\u201350.","DOI":"10.1016\/j.ajem.2009.06.009"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_008","doi-asserted-by":"crossref","unstructured":"Howard R, Carter B, Curry J, Morton N, Rivett K, Rose M, Tyrrell J, Walker S, Williams G, Association of Paediatric Anaesthetists of Great Britain and Ireland. Pain assessment. Paediatr Anaesth 2008;18(May (Suppl 1)):14\u20138.","DOI":"10.1111\/j.1155-5645.2008.02429.x"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_009","doi-asserted-by":"crossref","unstructured":"Olkkola KT, Hamunen K, Maunuksela EL. Clinical pharmacokinetics and pharmacodynamics of opioid analgesics in infants and children. Clin Pharmacokinet 1995;28:385\u2013404.","DOI":"10.2165\/00003088-199528050-00004"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_010","doi-asserted-by":"crossref","unstructured":"Moher D, Liberati A, Tetzlaff J, Altman DG and the Prisma group. Preferred reporting items for systematic reviews and meta-analyses: the Prisma statement. Ann Intern med 2009;151:264\u20139.","DOI":"10.7326\/0003-4819-151-4-200908180-00135"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_011","doi-asserted-by":"crossref","unstructured":"Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Cavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding? Control Clin Trials 1996;17:1\u201312.","DOI":"10.1016\/0197-2456(95)00134-4"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_012","doi-asserted-by":"crossref","unstructured":"Bounes V, Charpentier S, Houze-Cerfon CH, Bellard C, Ducass\u00e9 JL. Is there an ideal morphine dose for prehospital treatment of severe acute pain? A randomized, double-blind comparison of 2 doses. Am J Emerg Med 2008;26:148\u201354.","DOI":"10.1016\/j.ajem.2007.04.020"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_013","doi-asserted-by":"crossref","unstructured":"Bounes V, Barthelemy R, Diez O, Charpentier S, Montastruc JL, Ducasse JL. Sufentanil is not superior to morphine for the treatment of adult traumatic pain in an emergency setting: a randomized, double-blind, out-of-hospital trail. Ann Emerg Med 2010;56:509\u201316.","DOI":"10.1016\/j.annemergmed.2010.03.020"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_014","doi-asserted-by":"crossref","unstructured":"Galinski M, Dolveck F, Borron SW, Tual L, Van Laer V, Lardeur JY, Lapostolle F, Adnet F. A randomized, double-blind study comparing morphine with fentanyl in prehospital analgesia. Am J Emerg Med 2005;23:114\u20139.","DOI":"10.1016\/j.ajem.2004.03.010"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_015","doi-asserted-by":"crossref","unstructured":"Silfvast T, Saarnivaara L. Comparison of alfentanil and morphine in the prehospital treatment of patients with acute ischaemic-type chest pain. Eur J Emerg Med 2001;8:275\u20138.","DOI":"10.1097\/00063110-200112000-00005"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_016","doi-asserted-by":"crossref","unstructured":"Vergnion M, Degesves S, Garcet L, Magotteaux V. Tramadol, an alternative to morphine for treating posttraumatic pain in the prehospital situation. Anesth Analg 2001;92:1543\u20136.","DOI":"10.1097\/00000539-200106000-00039"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_017","doi-asserted-by":"crossref","unstructured":"Attard AR, Corlett MJ, Kidner NJ, Leslie AP, Fraser IA. Safety of early pain relief for acute abdominal pain. Brit Med J 1992;305:554\u20136.","DOI":"10.1136\/bmj.305.6853.554"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_018","doi-asserted-by":"crossref","unstructured":"Bartfield JM, Flint RD, McErlean M, Broderick J. Nebulized fentanyl for relief of abdominal pain. Acad Emerg Med 2003;10:215\u20138.","DOI":"10.1197\/aemj.10.3.215"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_019","doi-asserted-by":"crossref","unstructured":"Bektas F, Eken C, Karadeniz O, Goksu E, Cubuk M, Cete Y. Intravenous paracetamol or morphine for the treatment of renal colic: a randomized, placebo-controlled trial. Ann Emerg Med 2009;54:568\u201374.","DOI":"10.1016\/j.annemergmed.2009.06.501"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_020","doi-asserted-by":"crossref","unstructured":"Birnbaum A, Esses D, Bijur PE, Holden L, Gallagher EJ. Randomized double-blind placebo-controlled trial of two intravenous morphine dosages (0. 10 mg\/kg and 0. 15 mg\/kg) in emergency department patients with moderate to severe acute pain. Ann Emerg Med 2007;49:445\u201353.","DOI":"10.1016\/j.annemergmed.2006.06.030"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_021","doi-asserted-by":"crossref","unstructured":"Chang AK, Bijur PE, Meyer RH, Kenny Mk, Solorzano C, Gallagher EJ. Safety and Efficacy of hydromorphone as an analgesic alternative to morphine in acute pain: a randomized clinical trial. Ann Emerg Med 2006;48:164\u201372.","DOI":"10.1016\/j.annemergmed.2006.03.005"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_022","doi-asserted-by":"crossref","unstructured":"Chang AK. Efficacy and safety profile of a single dose of hydromorphone compared with morphine in older adults with acute, severe pain: a prospective, randomized, double-blind clinical trial. Am J Ger Pharmacother 2009;7:1\u201310.","DOI":"10.1016\/j.amjopharm.2009.02.002"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_023","doi-asserted-by":"crossref","unstructured":"Eray O, Cete Y, Oktay C, Karsli B, Cete N, Ersoy F. Intravenous single-dose tramadol versus meperidine for pain relief in renal colic. Eur J Anaesth 2002;19:368\u201370.","DOI":"10.1097\/00003643-200205000-00009"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_024","doi-asserted-by":"crossref","unstructured":"Gallagher EJ, Esses D, Lee C, Lahn Michael, Bijur PE. Randomized clinical trial of morphine in acute abdominal pain. Ann Emerg Med 2006;48:150\u201360.","DOI":"10.1016\/j.annemergmed.2005.11.020"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_025","doi-asserted-by":"crossref","unstructured":"Jasani NB, O\u2019Connor RE, Bouzokis JK. Comparison of hydromorphone and meperidine for ureteral colic. Acad Emerg Med 1994;1:539\u201343.","DOI":"10.1111\/j.1553-2712.1994.tb02549.x"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_026","doi-asserted-by":"crossref","unstructured":"Lovecchio F, Oster N, Sturmann K, Nelson LS, Flasher S, Finger R. The use of analgesics in patients with acute abdominal pain. J Emerg Med 1997;15:775\u20139.","DOI":"10.1016\/S0736-4679(97)00183-2"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_027","doi-asserted-by":"crossref","unstructured":"Miller PL, Ernst AA. Sex differences in analgesia: a randomized trial of u versus k opioid agonists. Southern Med J 2004;97:35\u201341.","DOI":"10.1097\/01.SMJ.0000085743.68121.A9"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_028","doi-asserted-by":"crossref","unstructured":"O\u2019Connor A, Schug SA, Cardwell H. A comparison of the efficacy and safety of morphine and pethidine as analgesia for suspected renal colic in the emergency setting. J Accid Emerg Med 2000;17:261\u20134.","DOI":"10.1136\/emj.17.4.261"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_029","doi-asserted-by":"crossref","unstructured":"Pace S, Burke TF. Intravenous morphine for early pain relief in patients with acute abdominal pain. Acad Emerg Med 1996;3:1086\u201392.","DOI":"10.1111\/j.1553-2712.1996.tb03365.x"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_030","doi-asserted-by":"crossref","unstructured":"Thomas SH, Silen W, Cheema F. Effects of morphine analgesia on diagnostic accuracy in emergency department patients with abdominal pain: a prospective, randomized trail. J Am Coll Surg 2003;196:18\u201331.","DOI":"10.1016\/S1072-7515(02)01480-1"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_031","doi-asserted-by":"crossref","unstructured":"Vermeulen B, Morabia A, Unger PF, Goehring C, Grangier C, Skljarov I, Terrier F. Acute appendicitis: influence of early pain relief on the accuracy of clinical and US findings in the decision to operate \u2013 a randomized trial. Radiology 1999;210:639\u201343.","DOI":"10.1148\/radiology.210.3.r99fe54639"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_032","unstructured":"Macintyre PE, Scott DA, Schug SA, Visser EJ, Walker SM. Acute pain management: scientific evidence. 3rd ed. Australian and New Zealand College of Anaesthetist and Faculty of Pain Medicine; 2010, http:\/\/www.anzca.edu.au\/resources\/book-and-publications."},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_033","doi-asserted-by":"crossref","unstructured":"Patenwala AE, Keim SM, Erstad BL. Intravenous opioids for severe acute pain in the emergency department. Ann Pharmacotherapy 2010;44: 1800\u20139.","DOI":"10.1345\/aph.1P438"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_034","doi-asserted-by":"crossref","unstructured":"McIntyre PE, Jarvis DA. Age is the best predictor of postoperative morphine requirements. Pain 1996;64:357\u201364.","DOI":"10.1016\/0304-3959(95)00128-X"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_035","doi-asserted-by":"crossref","unstructured":"Klepstad P, Dale O, Skorpen F, Borchgrevink PC, Kaasa S. Genetic variability and clinical efficacy of morphine. Acta Anaesthesiol Scand 2005;49: 902\u20138.","DOI":"10.1111\/j.1399-6576.2005.00772.x"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_036","doi-asserted-by":"crossref","unstructured":"Jones JJ, Johnson K, McNinch. Age as a risk factor for inadequate emergency department analgesia. Am J Emerg Med 1996;14:157\u201360.","DOI":"10.1016\/S0735-6757(96)90123-0"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_037","doi-asserted-by":"crossref","unstructured":"Bellville JW, Forrest Jr WH, Miller E, Brown Jr BW. Influence of age on pain relief from analgesics. A study of postoperative patients. JAMA 1971;27(217):1835\u201341.","DOI":"10.1001\/jama.1971.03190130039008"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_038","doi-asserted-by":"crossref","unstructured":"Liukas A, Kuusniemi K, Aantaa R, Virolainen P, Neuvonen M, Neuvonen PJ, Olkkola KT. Plasma concentrations of oral oxycodone are greatly increased in the elderly. Clin Pharm Ther 2008;84:462\u20137.","DOI":"10.1038\/clpt.2008.64"},{"key":"2025120909584177277_j_j.sjpain.2011.05.008_ref_039","doi-asserted-by":"crossref","unstructured":"Chang AK, Bijur PE, Napolitano A, Lupow J, Gallagher EJ. Two milligrams i. v. hydromorphone is efficacious for treating pain but is associated with oxygen desaturation. J Opioid Manag 2009;5:75\u201380.","DOI":"10.5055\/jom.2009.0008"}],"container-title":["Scandinavian Journal of Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyter.com\/view\/journals\/sjpain\/2\/4\/article-p187.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/api.elsevier.com\/content\/article\/PII:S1877886011000723?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/api.elsevier.com\/content\/article\/PII:S1877886011000723?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1016\/j.sjpain.2011.05.008\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1016\/j.sjpain.2011.05.008\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T12:12:56Z","timestamp":1765282376000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1016\/j.sjpain.2011.05.008\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,10,1]]},"references-count":39,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2011,10,1]]},"published-print":{"date-parts":[[2011,10,1]]}},"alternative-id":["10.1016\/j.sjpain.2011.05.008"],"URL":"https:\/\/doi.org\/10.1016\/j.sjpain.2011.05.008","relation":{},"ISSN":["1877-8860","1877-8879"],"issn-type":[{"value":"1877-8860","type":"print"},{"value":"1877-8879","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,10,1]]}}}