{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T03:30:06Z","timestamp":1791430206868,"version":"4.3.3"},"reference-count":109,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T00:00:00Z","timestamp":1683244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The vast majority of injured patients suffer from pain. Systematic assessment of pain on admission to the emergency department (ED) is a cornerstone of translating the best treatment strategies for patient care into practice. Pain must be measured with severity scales that are validated in clinical practice, including for specific populations (such as children and older adults). Although primary care ED of trauma patients focuses on resuscitation, diagnosis and treatment, pain assessment and management remains a critical element as professionals are not prepared to provide effective and early therapy. To date, most EDs have pain assessment and management protocols that take into account the patient\u2019s hemodynamic status and clinical condition and give preference to non-pharmacological approaches where possible. When selecting medications, the focus is on those that are least disruptive to hemodynamic status. Pain relief may still be necessary in hemodynamically unstable patients, but caution should be exercised, especially when using opioids, as absorption may be impaired or shock may be exacerbated. The analgesic dose of ketamine is certainly an attractive option. Fentanyl is clearly superior to other opioids in initial resuscitation and treatment as it has minimal effects on hemodynamic status and does not cause central nervous system depression. Inhaled analgesia techniques and ultrasound-guided nerve blocks are also increasingly effective solutions. A multimodal pain approach, which involves the use of two or more drugs with different mechanisms of action, plays an important role in the relief of trauma pain. All EDs must have policies and promote the adoption of procedures that use multimodal strategies for effective pain management in all injured patients.<\/jats:p>","DOI":"10.3390\/jcm12093289","type":"journal-article","created":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T04:55:50Z","timestamp":1683262550000},"page":"3289","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":70,"title":["The Pain Management of Trauma Patients in the Emergency Department"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9837-4638","authenticated-orcid":false,"given":"Andrea","family":"Fabbri","sequence":"first","affiliation":[{"name":"Emergency Department, AUSL Romagna, Presidio Ospedaliero Morgagni-Pierantoni, 47121 Forl\u00ec, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7309-6929","authenticated-orcid":false,"given":"Antonio","family":"Voza","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, 20089 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4936-1531","authenticated-orcid":false,"given":"Alessandro","family":"Riccardi","sequence":"additional","affiliation":[{"name":"Unit of Emergency Medicine, Ospedale San Paolo, 17121 Savona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sossio","family":"Serra","sequence":"additional","affiliation":[{"name":"Emergency Department, AUSL Romagna, Ospedale M. Bufalini, 47521 Cesena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Iaco","sequence":"additional","affiliation":[{"name":"Struttura Complessa di Medicina di Emergenza Urgenza, Ospedale Maria Vittoria, ASL Citt\u00e0 di Torino, 10144 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Petereit-Haack, G., Bolm-Audorff, U., Romero Starke, K., and Seidler, A. (2020). Occupational risk for post-traumatic stress disorder and trauma-related depression: A systematic review with meta-analysis. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17249369"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.mcna.2022.04.003","article-title":"Post-traumatic stress disorder","volume":"107","author":"Merians","year":"2023","journal-title":"Med. Clin. N. Am."},{"key":"ref_3","unstructured":"Kisser, R., Giustini, M., Rogmans, W., Turner, S., and EuroSafe (2023, February 20). Injuries in the European Union. Summary of Injury Statistics for the Years 2009\u20132018. Amsterdam, EuroSafe (European Association for Injury Prevention and Safety Promotion). Available online: https:\/\/www.eurosafe.eu.com\/uploads\/inline-files\/Report%20Injuries%20in%20EU%202009-2018%20FINAL%20SEPT%2021_pdf.pdf."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1097\/AJP.0b013e3182169036","article-title":"Prevalence and relief of pain in trauma patients in emergency medical services","volume":"27","author":"Berben","year":"2011","journal-title":"Clin. J. Pain"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1007\/s11739-020-02477-y","article-title":"Approaching acute pain in emergency settings: European Society for Emergency Medicine (EUSEM) guidelines-part 1: Assessment","volume":"15","author":"Coffey","year":"2020","journal-title":"Intern. Emerg. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1007\/s11739-020-02411-2","article-title":"Approaching acute pain in emergency settings; European Society for Emergency Medicine (EUSEM) guidelines-part 2: Management and recommendations","volume":"15","author":"Dobias","year":"2020","journal-title":"Intern. Emerg. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.jpain.2006.12.005","article-title":"PEMI Study Group. Pain in the emergency department: Results of the pain and emergency medicine initiative (PEMI) multicenter study","volume":"8","author":"Todd","year":"2007","journal-title":"J. Pain"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"818","DOI":"10.4102\/phcfm.v7i1.818","article-title":"Pain management in patients with long-bone fractures in a district hospital in KwaZulu-Natal, South Africa","volume":"7","author":"Awolola","year":"2015","journal-title":"Afr. J. Prim. Health Care Fam. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e000397","DOI":"10.1136\/bmjoq-2018-000397","article-title":"Improving analgesia prescription for trauma inpatients","volume":"7","author":"Stanger","year":"2018","journal-title":"BMJ Open Qual."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12245-016-0102-y","article-title":"Increased analgesia administration in emergency medicine after implementation of revised guidelines","volume":"9","author":"Idenburg","year":"2016","journal-title":"Int. J. Emerg. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2781","DOI":"10.2147\/JPR.S137992","article-title":"Prospective study on prevalence, intensity, type, and therapy of acute pain in a second-level urban emergency department","volume":"10","author":"Mura","year":"2017","journal-title":"J. Pain Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1186\/s13049-015-0166-3","article-title":"Assessment of pain in a Norwegian Emergency Department","volume":"23","author":"Dale","year":"2015","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_13","unstructured":"Royal College of Emergency Medicine (2023, February 28). Best Practice Guideline: Management of Pain in Adults. Available online: https:\/\/rcem.ac.uk\/wp-content\/uploads\/2021\/10\/RCEM_BPC_Management_of_Pain_in_Adults_300621.pdf."},{"key":"ref_14","first-page":"341","article-title":"Pain in the emergency department: Adherence to an implemented treatment protocol","volume":"140","author":"Stephan","year":"2010","journal-title":"Swiss Med. Wkly."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/ALN.0b013e3181c5dfd7","article-title":"Ultrasound imaging for regional anesthesia in infants, children, and adolescents: A review of current literature and its application in the practice of extremity and trunk blocks","volume":"112","author":"Tsui","year":"2010","journal-title":"Anesthesiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"763","DOI":"10.23736\/S0375-9393.19.13145-8","article-title":"Acute pain management in trauma: Anatomy, ultrasound-guided peripheral nerve blocks and special considerations","volume":"85","author":"Saranteas","year":"2019","journal-title":"Minerva Anestesiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.anclin.2022.04.002","article-title":"Multimodal analgesia","volume":"40","author":"Lirk","year":"2022","journal-title":"Anesthesiol. Clin."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.11124\/JBIES-20-00189","article-title":"Non-pharmacological interventions for acute pain management in adult trauma victims: A scoping review","volume":"19","author":"Mota","year":"2021","journal-title":"JBI Evid. Synth."},{"key":"ref_19","first-page":"55","article-title":"Pain assessment in infants and young children: The FLACC scale","volume":"102","author":"Merkel","year":"2002","journal-title":"Am. J. Nurs."},{"key":"ref_20","first-page":"140","article-title":"Clinical validation of FLACC: Preverbal patient pain scale","volume":"29","author":"Manworren","year":"2003","journal-title":"Pediatr. Nurs."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.annemergmed.2017.08.041","article-title":"Acetaminophen or nonsteroidal anti-Inflammatory drugs in acute musculoskeletal trauma: A multicenter, double-blind, randomized, clinical trial","volume":"71","author":"Ridderikhof","year":"2018","journal-title":"Ann. Emerg. Med."},{"key":"ref_22","first-page":"e2020006","article-title":"Assessment and pain management during the triage phase of children with extremity trauma. A retrospective analysis in a Pediatric Emergency Room after the introduction of the PIPER recommendations","volume":"90","author":"Granata","year":"2020","journal-title":"Acta Biomed."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1067\/mem.2001.118863","article-title":"Prospective validation of clinically important changes in pain severity measured on a visual analog scale","volume":"38","author":"Gallagher","year":"2001","journal-title":"Ann. Emerg. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/01.JAM.0000043422.31640.F7","article-title":"Development and psychometric evaluation of the pain assessment in advanced dementia (PAINAD) scale","volume":"4","author":"Warden","year":"2003","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1503\/cmaj.140907","article-title":"Oral administration of morphine versus ibuprofen to manage post fracture pain in children: A randomized trial","volume":"186","author":"Poonai","year":"2014","journal-title":"CMAJ"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1097\/j.pain.0000000000000756","article-title":"Persistent pain after motor vehicle collision: Comparative effectiveness of opioids vs nonsteroidal antiinflammatory drugs prescribed from the emergency department-a propensity matched analysis","volume":"158","author":"Beaudoin","year":"2017","journal-title":"Pain"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1227\/NEU.0000000000001432","article-title":"Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition","volume":"80","author":"Carney","year":"2017","journal-title":"Neurosurgery"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s00101-021-01051-1","article-title":"Volatile anesthetics for prehospital analgesia by paramedics-An overview","volume":"71","author":"Trimmel","year":"2022","journal-title":"Anaesthesist"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1016\/j.ajem.2017.01.004","article-title":"Intranasal fentanyl and inhaled nitrous oxide for fracture reduction: The FAN observational study","volume":"35","author":"Hoeffe","year":"2017","journal-title":"Am. J. Emerg. Med."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"K\u00f6tter, T., da Costa, B.R., F\u00e4ssler, M., Blozik, E., Linde, K., J\u00fcni, P., Reichenbach, S., and Scherer, M. (2015). Metamizole-associated adverse events: A systematic review and meta-analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0122918"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1111\/jcpt.12422","article-title":"Safety of metamizole: A systematic review of the literature","volume":"41","author":"Andrade","year":"2016","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1007\/s40264-022-01198-9","article-title":"Hip fracture risk after treatment with tramadol or codeine: An observational study","volume":"45","author":"Voss","year":"2022","journal-title":"Drug Saf."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"327","DOI":"10.2147\/JPR.S33112","article-title":"Tramadol\/paracetamol fixed-dose combination in the treatment of moderate to severe pain","volume":"5","author":"Pergolizzi","year":"2012","journal-title":"J. Pain Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1382.e1","DOI":"10.1016\/j.amjmed.2018.04.025","article-title":"Tramadol: Understanding the risk of serotonin syndrome and seizures","volume":"131","author":"Hassamal","year":"2018","journal-title":"Am. J. Med."},{"key":"ref_35","first-page":"CD007789","article-title":"Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury","volume":"8","author":"Jones","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"273","DOI":"10.2147\/CIA.S1847","article-title":"Opiates and elderly: Use and side effects","volume":"3","author":"Chau","year":"2008","journal-title":"Clin. Interv. Aging"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1001\/jama.2016.1464","article-title":"CDC Guideline for Prescribing Opioids for Chronic Pain\u2014United States, 2016","volume":"315","author":"Dowell","year":"2016","journal-title":"JAMA"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1523\/JNEUROSCI.4060-10.2011","article-title":"Multiple targets of \u03bc-opioid receptor-mediated presynaptic inhibition at primary afferent A\u03b4- and C-fibers","volume":"31","author":"Heinke","year":"2011","journal-title":"J. Neurosci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1124\/mol.112.081992","article-title":"Modulation of \u03bc-opioid receptor signaling by RGS19 in SH-SY5Y cells","volume":"83","author":"Wang","year":"2013","journal-title":"Mol. Pharmacol."},{"key":"ref_40","first-page":"97","article-title":"Pain relief is a human right","volume":"1","author":"Daher","year":"2010","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"225","DOI":"10.2165\/00003088-199733030-00005","article-title":"Pharmacokinetic optimization of opioid treatment in acute pain therapy","volume":"33","author":"Upton","year":"1997","journal-title":"Clin. Pharmacokinet."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/0304-3959(90)90049-J","article-title":"Profiles of opioid analgesia in humans after intravenous bolus administration: Alfentanil, fentanyl and morphine compared on experimental pain","volume":"43","author":"Chapman","year":"1990","journal-title":"Pain"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1111\/j.1365-2125.2009.03456.x","article-title":"Assessing analgesic actions of opioids by experimental pain models in healthy volunteers\u2014An updated review","volume":"68","author":"Staahl","year":"2009","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"501","DOI":"10.3109\/15563650.2015.1049355","article-title":"CYP2D6 genetic polymorphisms and their relevance for poisoning due to amfetamines, opioid analgesics and antidepressants","volume":"53","author":"Haufroid","year":"2015","journal-title":"Clin. Toxicol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1007\/s12325-012-0051-7","article-title":"Opioid rotation in clinical practice","volume":"29","author":"Nalamachu","year":"2012","journal-title":"Adv. Ther."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1097\/ALN.0b013e3181e90914","article-title":"Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery","volume":"113","author":"Loftus","year":"2010","journal-title":"Anesthesiology"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1097\/ACO.0000000000000916","article-title":"Ketamine: A versatile tool for anesthesia and analgesia","volume":"33","author":"Barrett","year":"2020","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1111\/j.1399-6576.2011.02446.x","article-title":"Ketamine as an analgesic in the pre-hospital setting: A systematic review","volume":"55","author":"Jennings","year":"2011","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1007\/s40262-016-0383-6","article-title":"Ketamine: A Review of Clinical Pharmacokinetics and Pharmacodynamics in Anesthesia and Pain Therapy","volume":"55","author":"Peltoniemi","year":"2016","journal-title":"Clin. Pharmacokinet."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1124\/pr.117.015198","article-title":"Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms","volume":"70","author":"Zanos","year":"2018","journal-title":"Pharmacol. Rev."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1213\/01.ANE.0000118109.12855.07","article-title":"Ketamine as adjuvant analgesic to opioids: A quantitative and qualitative systematic review","volume":"99","author":"Subramaniam","year":"2004","journal-title":"Anesth. Analg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/j.1399-6576.1997.tb04624.x","article-title":"NMDA receptor antagonists: Interactions with opioids","volume":"41","author":"Dickenson","year":"1997","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_53","first-page":"456","article-title":"Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists","volume":"43","author":"Schwenk","year":"2018","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1002\/emp2.12023","article-title":"Out-of-hospital ketamine: Review of a growing trend in patient care","volume":"1","author":"Kitch","year":"2020","journal-title":"J. Am. Coll. Emerg. Physicians Open"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"272","DOI":"10.5811\/westjem.2019.10.43067","article-title":"Ketamine safety and use in the Emergency Department for pain and agitation\/delirium: A Health System Experience","volume":"21","author":"Mo","year":"2020","journal-title":"West. J. Emerg. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1177\/0960327115578743","article-title":"Analgesic use of inhaled methoxyflurane: Evaluation of its potential nephrotoxicity","volume":"35","author":"Dayan","year":"2016","journal-title":"Hum. Exp. Toxicol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"11","DOI":"10.2147\/JPR.S150600","article-title":"Management of trauma pain in the emergency setting: Low-dose methoxyflurane or nitrous oxide? A systematic review and indirect treatment comparison","volume":"11","author":"Porter","year":"2017","journal-title":"J. Pain Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"3030","DOI":"10.1007\/s12325-019-01055-9","article-title":"Analgesic efficacy, practicality and safety of inhaled methoxyflurane versus standard analgesic treatment for acute trauma pain in the emergency setting: A Randomised, Open-Label, Active-Controlled, Multicentre Trial in Italy (MEDITA)","volume":"36","author":"Mercadante","year":"2019","journal-title":"Adv. Ther."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"93","DOI":"10.2147\/JPR.S292521","article-title":"Low-dose methoxyflurane versus standard of care analgesics for emergency trauma pain: A systematic review and meta-analysis of pooled data","volume":"14","author":"Fabbri","year":"2021","journal-title":"J. Pain Res."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.jss.2022.04.032","article-title":"Less is more: A multimodal pain management strategy is associated with reduced opioid use in hospitalized trauma patients","volume":"278","author":"Kay","year":"2022","journal-title":"J. Surg. Res."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1016\/j.amjsurg.2019.09.032","article-title":"Implementation of a multi-modal pain regimen to decrease inpatient opioid exposure after injury","volume":"218","author":"Wei","year":"2019","journal-title":"Am. J. Surg."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.jamcollsurg.2020.12.014","article-title":"Multi-modal analgesic strategy for trauma: A pragmatic randomized clinical trial","volume":"232","author":"Harvin","year":"2021","journal-title":"J. Am. Coll. Surg."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1097\/ALN.0000000000003572","article-title":"Perioperative Opioid Administration","volume":"134","author":"Shanthanna","year":"2021","journal-title":"Anesthesiology"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.joen.2016.09.010","article-title":"Nonsteroidal anti-inflammatory drugs for managing postoperative endodontic pain in patients who present with preoperative pain: A systematic review and meta-analysis","volume":"43","author":"Smith","year":"2017","journal-title":"J. Endod."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13049-019-0588-4","article-title":"Prehospital intravenous fentanyl administered by ambulance personnel: A cluster-randomised comparison of two treatment protocols","volume":"27","author":"Friesgaard","year":"2019","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_66","first-page":"89","article-title":"Pain management in trauma: A review study","volume":"8","author":"Ahmadi","year":"2016","journal-title":"J. Inj. Violence Res."},{"key":"ref_67","first-page":"A4563","article-title":"Limited evidence for intranasal fentanyl in the emergency department and the prehospital setting\u2014A systematic review","volume":"60","author":"Hansen","year":"2013","journal-title":"Dan. Med. J."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"45","DOI":"10.2147\/LRA.S55322","article-title":"Regional anesthesia for the trauma patient: Improving patient outcomes","volume":"8","author":"Gadsden","year":"2015","journal-title":"Local Reg. Anesth."},{"key":"ref_69","first-page":"A138","article-title":"B108\u2005From epidural to fascial plane in blunt chest trauma","volume":"47","author":"Singh","year":"2022","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1097\/TA.0000000000001209","article-title":"Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society","volume":"81","author":"Galvagno","year":"2016","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1177\/1090820X14543102","article-title":"Local anesthetic systemic toxicity","volume":"34","author":"Dickerson","year":"2014","journal-title":"Aesthet. Surg. J."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"S105","DOI":"10.36076\/ppj.2008\/11\/S105","article-title":"Opioid complications and side effects","volume":"11","author":"Benyamin","year":"2008","journal-title":"Pain Physician"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"713","DOI":"10.7150\/ijms.22643","article-title":"Lipid emulsion for treating local anesthetic systemic toxicity","volume":"15","author":"Ok","year":"2018","journal-title":"Int. J. Med. Sci."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"398","DOI":"10.5505\/tjtes.2013.86383","article-title":"Acute pain management with intravenous 0.10 mg\/kg vs. 0.15 mg\/kg morphine sulfate in limb traumatized patients: A randomized double-blinded placebo-controlled trial","volume":"19","author":"Farsi","year":"2013","journal-title":"Ulus. Travma Acil Cerrahi Derg."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.annemergmed.2011.11.012","article-title":"Morphine and ketamine is superior to morp, hine alone for out-of-hospital trauma analgesia: A randomized controlled trial","volume":"59","author":"Jennings","year":"2012","journal-title":"Ann. Emerg. Med."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1111\/j.1553-2712.2011.01133.x","article-title":"Ketamine\/propofol versus midazolam\/fentanyl for procedural sedation and analgesia in the emergency department: A randomized, prospective, double-blind trial","volume":"18","author":"Nejati","year":"2011","journal-title":"Acad. Emerg. Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.annemergmed.2011.11.004","article-title":"Nurse-administered ketamine sedation in an emergency department in rural Uganda","volume":"59","author":"Bisanzo","year":"2012","journal-title":"Ann. Emerg. Med."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.ajem.2014.12.058","article-title":"Low-dose ketamine vs morphine for acute pain in the ED: A randomized controlled trial","volume":"33","author":"Miller","year":"2015","journal-title":"Am. J. Emerg. Med."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"257","DOI":"10.3109\/10903127.2013.851307","article-title":"A comparison of ketamine and morphine analgesia in prehospital trauma care: A cluster randomized clinical trial in rural Quang Tri province, Vietnam","volume":"18","author":"Tran","year":"2014","journal-title":"Prehosp. Emerg. Care"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1007\/s00213-005-2151-4","article-title":"Associative and behavioral tolerance to the analgesic effects of nicotine in rats: Tail-flick and paw-lick assays","volume":"180","author":"Davis","year":"2005","journal-title":"Psychopharmacology"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1136\/archdischild-2016-310869","article-title":"NICE clinical guideline NG39: Major trauma: Assessment and initial management","volume":"102","author":"Kanani","year":"2017","journal-title":"Arch. Dis. Child. Educ. Pract. Ed."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"14","DOI":"10.5694\/j.1326-5377.2007.tb01108.x","article-title":"The relationship between compensable status and long-term patient outcomes following orthopaedic trauma","volume":"187","author":"Gabbe","year":"2007","journal-title":"Med. J. Aust."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"149","DOI":"10.5694\/mja12.11179","article-title":"Patient perspectives of care in a regionalised trauma system: Lessons from the Victorian State Trauma System","volume":"198","author":"Gabbe","year":"2013","journal-title":"Med. J. Aust."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.ajem.2006.11.016","article-title":"Management of severe acute pain in emergency settings: Ketamine reduces morphine consumption","volume":"25","author":"Galinski","year":"2007","journal-title":"Am. J. Emerg. Med."},{"key":"ref_85","first-page":"785","article-title":"Analgesia in Patients with Trauma in Emergency Medicine","volume":"114","author":"Bouillon","year":"2017","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.annemergmed.2015.03.004","article-title":"Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial","volume":"66","author":"Motov","year":"2015","journal-title":"Ann. Emerg. Med."},{"key":"ref_87","first-page":"231","article-title":"Intravenous ketamine is as effective as midazolam\/fentanyl for procedural sedation and analgesia in the emergency department","volume":"66","author":"Jamal","year":"2011","journal-title":"Med. J. Malays."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.ajem.2012.06.012","article-title":"Comparison of ketamine-low-dose midozolam with midazolam-fentanyl for orthopedic emergencies: A double-blind randomized trial","volume":"31","author":"Cevik","year":"2013","journal-title":"Am. J. Emerg. Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.ajem.2004.03.010","article-title":"A randomized, double-blind study comparing morphine with fentanyl in prehospital analgesia","volume":"23","author":"Galinski","year":"2005","journal-title":"Am. J. Emerg. Med."},{"key":"ref_90","first-page":"639","article-title":"\u00ecAnalgesie in der Notfallmedizin [Analgesia as an important component of emergency care]","volume":"58","author":"Stork","year":"2009","journal-title":"Anaesthesist"},{"key":"ref_91","unstructured":"NHS (2023, March 02). Paracetamol for Adults. Updated 20 October 2022. Available online: https:\/\/www.nhs.uk\/medicines\/paracetamol-for-adults\/."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1136\/annrheumdis-2014-206914","article-title":"Paracetamol: Not as safe as we thought? A systematic literature review of observational studies","volume":"75","author":"Roberts","year":"2016","journal-title":"Ann. Rheum. Dis."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.jemermed.2019.06.026","article-title":"Analgesic effect of nitrous oxide\/oxygen mixture for traumatic pain in the Emergency Department: A randomized, double-blind study","volume":"57","author":"Gao","year":"2019","journal-title":"J. Emerg. Med."},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Trimmel, H., Egger, A., Doppler, R., Pimiskern, M., and Voelckel, W.G. (2022). Usability and effectiveness of inhaled methoxyflurane for prehospital analgesia\u2014A prospective, observational study. BMC Emerg. Med., 22.","DOI":"10.1186\/s12873-021-00565-6"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"2050312119841823","DOI":"10.1177\/2050312119841823","article-title":"Healthcare professionals\u2019 perceptions on the use of opioid analgesics for the treatment of cancer-related pain in Cyprus: A mixed-method study","volume":"7","author":"Charalambous","year":"2019","journal-title":"SAGE Open Med."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"2479","DOI":"10.2147\/JPR.S138850","article-title":"Evaluation of the effectiveness and efficiency of the triage emergency department nursing protocol for the management of pain","volume":"10","author":"Butti","year":"2017","journal-title":"J. Pain Res."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1111\/j.1533-2500.2009.00277.x","article-title":"Acute pain and availability of analgesia in the prehospital emergency setting in Italy: A problem to be solved","volume":"9","author":"Marinangeli","year":"2009","journal-title":"Pain Pract."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1155\/2015\/868746","article-title":"Denial of pain medication by health care providers predicts in-hospital illicit drug use among individuals who use illicit drugs","volume":"20","author":"Ti","year":"2015","journal-title":"Pain Res. Manag."},{"key":"ref_99","first-page":"5","article-title":"Problems and barriers of pain management in the emergency department: Are we ever going to get better?","volume":"2","author":"Motov","year":"2008","journal-title":"J. Pain Res."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1111\/ajad.12466","article-title":"Social context and perspectives of non-medical prescription opioid use among young adults in Rhode Island: A qualitative study","volume":"25","author":"Yedinak","year":"2016","journal-title":"Am. J. Addict."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1111\/j.1526-4637.2010.00983.x","article-title":"Causes and consequences of inadequate management of acute pain","volume":"11","author":"Sinatra","year":"2010","journal-title":"Pain Med."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.ajem.2019.06.001","article-title":"Side effects from opioids used for acute pain after emergency department discharge","volume":"38","author":"Daoust","year":"2020","journal-title":"Am. J. Emerg. Med."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1056\/NEJMra1507771","article-title":"Opioid abuse in chronic pain. Misconceptions and mitigation strategies","volume":"374","author":"Volkow","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_104","first-page":"e45","article-title":"Pain management in the Emergency Department: A review article on options and methods","volume":"2","author":"Abdolrazaghnejad","year":"2018","journal-title":"Adv. J. Emerg. Med."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.respe.2015.11.010","article-title":"Impact of a pilot team on patients\u2019 pain reduction and satisfaction in an emergency department: A before-and-after observational study","volume":"64","author":"Kone","year":"2016","journal-title":"Rev. Epidemiol. Sante Publique"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s40122-021-00346-w","article-title":"Opioids for treatment of pre-hospital acute pain: A systematic review","volume":"11","author":"Friesgaard","year":"2022","journal-title":"Pain Ther."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1517\/17425255.2014.864636","article-title":"Pharmacokinetic and pharmacodynamic modeling for acute and chronic pain drug assessment","volume":"10","author":"Yang","year":"2014","journal-title":"Expert Opin. Drug Metab. Toxicol."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"2595","DOI":"10.2147\/JPR.S151077","article-title":"Project for the introduction of prehospital analgesia with fentanyl and morphine administered by specially trained paramedics in a rural service area in Germany","volume":"10","author":"Scharonow","year":"2017","journal-title":"J. Pain Res."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.annemergmed.2007.07.008","article-title":"Emergency department crowding is associated with poor care for patients with severe pain","volume":"51","author":"Pines","year":"2008","journal-title":"Ann. Emerg. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/9\/3289\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:29:36Z","timestamp":1760124576000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/9\/3289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,5]]},"references-count":109,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["jcm12093289"],"URL":"https:\/\/doi.org\/10.3390\/jcm12093289","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,5]]}}}