{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:46:54Z","timestamp":1792622814954,"version":"4.5.0"},"reference-count":134,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T00:00:00Z","timestamp":1687910400000},"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>Access to pain management is a fundamental human right for all people, including those who are at the end of life (EOL). In end-stage patients, severe and uncontrolled pain is a common cause of admission to the emergency department (ED), and its treatment is challenging due to its complex, often multifactorial genesis. The aim of this narrative review was to identify the available literature on the management of severe EOL pain in the ED. The MEDLINE, SCOPUS, EMBASE, and CENTRAL databases were searched from inception to 1 April 2023 including randomised controlled trials, observational studies, systemic or narrative reviews, case reports, and guidelines on the management of EOL pain in the ED. A total of 532 articles were identified, and 9 articles were included (5 narrative reviews, 2 retrospective studies, and 2 prospective studies). Included studies were heterogeneous on the scales used and recommended for pain assessment and the recommended treatments. No study provided evidence for a better approach for EOL patients with pain in the ED. We provide a narrative summary of the findings and a review of the management of EOL pain in clinical practice, including (i) the identification of the EOL patients and unmet palliative care needs, (ii) a multidimensional, patient-centred assessment of the type and severity of pain, (iii) a multidisciplinary approach to the management of end-of-life pain, including an overview of non-pharmacological and pharmacological techniques; and (iv) the management of special situations, including rapid acute deterioration of chronic pain, breakthrough pain, and sedative palliation.<\/jats:p>","DOI":"10.3390\/jcm12134357","type":"journal-article","created":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T01:15:47Z","timestamp":1688001347000},"page":"4357","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach"],"prefix":"10.3390","volume":"12","author":[{"given":"Sossio","family":"Serra","sequence":"first","affiliation":[{"name":"Emergency Department, Maurizio Bufalini Hospital, 47521 Cesena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2285-327X","authenticated-orcid":false,"given":"Michele Domenico","family":"Spampinato","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine and for Romagna, University of Ferrara, 44124 Ferrara, 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":"Pronto Soccorso Ospedale di Imperia, 18100 Imperia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Guarino","sequence":"additional","affiliation":[{"name":"UOC MEU Ospedale CTO-AORN dei Colli Napoli, 80131 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9837-4638","authenticated-orcid":false,"given":"Andrea","family":"Fabbri","sequence":"additional","affiliation":[{"name":"Emergency Department, AUSL Romagna, Presidio Ospedaliero Morgagni-Pierantoni, 47121 Forl\u00ec, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciano","family":"Orsi","sequence":"additional","affiliation":[{"name":"Palliative Care Physician and Scientific Director of \u201cRivista Italiane di Cure Palliative\u201d, 26013 Crema, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio De","family":"De 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":[[2023,6,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"563","DOI":"10.7326\/0003-4819-153-9-201011020-00005","article-title":"The epidemiology of pain during the last 2 years of life","volume":"153","author":"Smith","year":"2010","journal-title":"Ann. 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