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This clinical review focuses on individualized, evidence-based approaches to ED pain management in four vulnerable groups: pregnant and breastfeeding patients, patients with sickle cell disease, geriatric populations, and patients with cancer pain and requiring palliative care. The practical recommendations presented in this review for optimal ED pain management in these special populations call for timely, effective, and multimodal analgesia; prioritization of nonpharmacologic and pain syndrome-targeted techniques; awareness of drug-disease and drug-drug interactions; interdisciplinary coordination; and education to mitigate ED clinicians\u2019 biases. This review emphasizes the importance of tailoring pain strategies to population-specific needs to improve outcomes, reduce harm, and advance equity in emergency care delivery.<\/jats:p>","DOI":"10.4103\/tjem.tjem_141_25","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T10:00:08Z","timestamp":1751364008000},"page":"159-177","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Emergency department pain management in special populations"],"prefix":"10.4103","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9763-7144","authenticated-orcid":false,"given":"Katherine","family":"Vlasica","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, St. Joseph\u2019s Health, Paterson, NJ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8984-7050","authenticated-orcid":false,"given":"Amanda","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, St. Joseph\u2019s Health, Paterson, NJ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0081-7013","authenticated-orcid":false,"given":"Mohammad Anzal","family":"Rehman","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Mediclinic City Hospital, Dubai, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2506-5252","authenticated-orcid":false,"given":"George","family":"Notas","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University Hospital of Heraklion, Crete, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2944-8581","authenticated-orcid":false,"given":"Christina","family":"Shenvi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University North Carolina Hospitals, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9668-216X","authenticated-orcid":false,"given":"Sergey","family":"Motov","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"R1-20260422","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.ajem.2014.01.015","article-title":"Prevalence and treatment of pain in EDs in the United States, 2000 to 2010","volume":"32","author":"Chang","year":"2014","journal-title":"Am J Emerg Med"},{"key":"R2-20260422","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1053\/ajem.2002.32643","article-title":"The high prevalence of pain in emergency medical care","volume":"20","author":"Cordell","year":"2002","journal-title":"Am J Emerg Med"},{"key":"R3-20260422","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.ogc.2022.10.016","article-title":"Analgesia in pregnancy","volume":"50","author":"Matthews","year":"2023","journal-title":"Obstet Gynecol Clin North Am"},{"key":"R4-20260422","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1002\/ajh.24948","article-title":"A randomized controlled trial comparing two vaso-occlusive episode (VOE) protocols in sickle cell disease (SCD)","volume":"93","author":"Tanabe","year":"2018","journal-title":"Am J Hematol"},{"key":"R5-20260422","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1111\/jgs.18372","article-title":"American Geriatrics Society 2023 updated AGS beers criteria\u00ae for potentially inappropriate medication use in older adults","volume":"71","year":"2023","journal-title":"J Am Geriatr Soc"},{"key":"R6-20260422","first-page":"182","article-title":"Optimal pain management for patients with cancer in the modern era","volume":"68","author":"Scarborough","year":"2018","journal-title":"CA Cancer J Clin"},{"key":"R7-20260422","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1177\/10600280231167775","article-title":"Considerations for treating nonobstetric diseases in pregnant patients in the emergency department setting","volume":"57","author":"Eiland","year":"2023","journal-title":"Ann Pharmacother"},{"key":"R8-20260422","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1007\/s40265-023-01906-4","article-title":"Pharmacologic management of cancer-related pain in pregnant patients","volume":"83","author":"Zerfas","year":"2023","journal-title":"Drugs"},{"key":"R11-20260422","doi-asserted-by":"crossref","first-page":"B14","DOI":"10.1016\/j.ajog.2017.01.021","article-title":"Electronic address: pubs@smfm.org. 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