Acute pain management scientific evidence fifth edition 2020. Australian and New Zealand College of Anaesthetists and the Faculty of Pain Medicine.

Massachusetts Pain Initiative: Pain Management Pocket Tool, version May 2023

Acute pain control, The Society for Academic Emergency Medicine (SAEM) , updated 2023

CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. MMWR Recomm Rep 2022;71(No. RR-3):1–95. DOI:

Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management, ICSI, 8e edition, updated september 2019

ICSI Guideline

Guidelines for the management of acute pain in emergency situations, The European Society for Emergency Medicine (EUSEM), march 2020

General Pathways of Pain Sensation and the Major Neurotransmitters Involved in Pain Regulation. Yam MF, Loh YC, Tan CS, Khadijah Adam S, Abdul Manan N, Basir R.  Int J Mol Sci. 2018 Jul 24;19(8):2164. doi: 10.3390/ijms19082164. PMID: 30042373; PMCID: PMC6121522.

Acute Pain Service Handbook, A peer reviewed referenced resource, 2010, First Canadian Edition 

Pain Management in the Emergency Department: a Review Article on Options and Methods. Abdolrazaghnejad A, Banaie M, Tavakoli N, Safdari M, Rajabpour-Sanati A.  Adv J Emerg Med. 2018 Jun 24;2(4):e45. doi: 10.22114/AJEM.v0i0.93. PMID: 31172108; PMCID: PMC6548151.

Why is pain management so difficult in the Emergency Department? A systematic mixed studies review and thematic synthesis of staff perceptions of enablers and barriers to pain management within the Emergency Department, Sampson FC, Johnson M, Emergency Medicine Journal Published Online First: 06 June 2023. doi: 10.1136/emermed-2022-212759

Comparison of intravenous paracetamol (acetaminophen) to intravenously or intramuscularly administered non-steroidal anti-inflammatory drugs (NSAIDs) or opioids for patients presenting with moderate to severe acute pain conditions to the ED: systematic review and meta-analysis. Qureshi I, Abdulrashid K, Thomas SH, Abdel-Rahman ME, Pathan SA, Harris T.  Emerg Med J. 2023 May 12:emermed-2022-212869. doi: 10.1136/emermed-2022-212869. Epub ahead of print. PMID: 37173122.

Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews. Ferreira GE, Abdel-Shaheed C, Underwood M, Finnerup NB, Day RO, McLachlan A, Eldabe S, Zadro JR, Maher CG. BMJ. 2023 Feb 1;380:e072415. doi: 10.1136/bmj-2022-072415. PMID: 36725015; PMCID: PMC9887507.

Analgesia in the emergency department: a GRADE-based evaluation of research evidence and recommendations for practice. Lipp C, Dhaliwal R, Lang E. Critical Care. 2013;17(2):212. doi:10.1186/cc12521.

Stephen H. Thomas, “Management of Pain in the Emergency Department,” ISRN Emergency Medicine, vol. 2013, Article ID 583132, 19 pages, 2013. doi:10.1155/2013/583132

A Review of Current and Emerging Approaches to Pain Management in the Emergency Department, Knox H. Todd, Pain Ther. 2017 Dec; 6(2): 193–202. 

Analgesia in the emergency department: why is it not administered? Kant J, Dombagolla M, Lai F, Hendarto A, Taylor DM. Emerg Med J. 2018 Oct 30. pii: emermed-2018-207629. doi: 10.1136/emermed-2018-207629. [Epub ahead of print]

Variables associated with administration of analgesia, nurse-initiated analgesia and early analgesia in the emergency department. Taylor DM, Chen J, Khan M, et al. Emerg Med J 2017;34:13-19

Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study. Todd KH, Ducharme J, Choiniere M, Crandall CS, Fosnocht DE, Homel P, Tanabe P; PEMI Study Group. J Pain. 2007 Jun;8(6):460-6. Epub 2007 Feb 15

There is oligo-evidence for oligoanalgesia. Green SM. Ann Emerg Med. 2012 Aug;60(2):212-4. doi: 10.1016/j.annemergmed.2012.06.006. No abstract available. PMID: 22818368

Comparison of acetaminophen, ketamine, or ketorolac versus morphine in the treatment of acute renal colic: A network meta-analysis. Alghamdi YA, Morya RE, Bahathiq DM, Bokhari AF, Alaboud AK, Abdulhamid AS, Ghaddaf AA, Jamjoom M. Am J Emerg Med. 2023 Aug 19:S0735-6757(23)00447-3. doi: 10.1016/j.ajem.2023.08.029. Epub ahead of print. PMID: 37679264.

Acétaminophène (Paracetamol)

Comparing the analgesic effect of intravenous paracetamol with morphine on patients with renal colic pain: A meta-analysis of randomized controlled studies. Zhili X, Linglong C, Shuang J, et al.  Am J Emerg Med. 2020 Apr 2. pii: S0735-6757(20)30217-5. doi: 10.1016/j.ajem.2020.03.061. (Systematic review)

Conclusions: Intravenous paracetamol may result in lower pain scores at 30 min than morphine for renal colic pain, and more studies should be conducted to compare their analgesic efficacy.

Intravenous versus Oral Acetaminophen for Pain: Systematic Review of Current Evidence to Support Clinical Decision-Making, JCPH, Vol 68, No 3 (2015) 


Oral non‐steroidal anti‐inflammatory drugs versus other oral analgesic agents for acute soft tissue injury, Cochrane Systematic Review - Intervention Version published: 12 August 2020

Oral analgesic for musculoskeletal injuries in children: A systematic review and network meta-analysis. Utsumi S, Amagasa S, Moriwaki T, Uematsu S.  Acad Emerg Med. 2023 Sep 9. doi: 10.1111/acem.14803. Epub ahead of print. PMID: 37688572.

Comparison of Oral Ibuprofen at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial, Motov S, Masoudi A, Drapkin J, Sotomayor C, Kim S, Butt M, Likourezos A, Fassassi C, Hossain R, Brady J, Rothberger N, Flom P, Marshall J., Annals of Emergency Medicine 2019 August 2

CONCLUSION: Oral ibuprofen administered at doses of 400, 600, and 800 mg has similar analgesic efficacy for short-term pain relief in adult patients presenting to the ED with acute pain.


Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews. Ferreira GE, Abdel-Shaheed C, Underwood M, Finnerup NB, Day RO, McLachlan A, Eldabe S, Zadro JR, Maher CG. BMJ. 2023 Feb 1;380:e072415. doi: 10.1136/bmj-2022-072415. PMID: 36725015; PMCID: PMC9887507.

Cannabis et Canabinoïdes

Lignes directrices simplifiées en matière de prescription de cannabinoïdes médicaux en soins de première ligne. Can Fam Physician. 2018 Feb; 64(2): e64–e75. 

Est-ce que le cannabis naturel est une option thérapeutique efficace pour le soulagement de la douleur chronique chez les adultes? InfoPratique, 12 octobre 2018

Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, Keurentjes JC, Lang S, Misso K, Ryder S, Schmidlkofer S, Westwood M, Kleijnen J. JAMA. 2015 Jun 23-30;313(24):2456-73. doi: 10.1001/jama.2015.6358. Review. Erratum in: JAMA. 2016 Apr 12;315(14):1522. Erratum in: JAMA. 2015 Aug 4;314(5):520. JAMA. 2015 Aug 25;314(8):837. JAMA. 2015 Dec 1;314(21):2308. 

Cannabis, INSPQ


The use of intranasal analgesia for acute pain control in the emergency department: A literature review, Billy Sin, Jennifer Wiafe, Christine Ciaramella, Luis Valdez, Sergey M Motov, American Journal of Emergency Medicine 2017 November 20
Conclusion: Eleven randomized controlled trials with various methodological flaws revealed conflicting conclusions. There is limited evidence to support the use of the IN analgesia over traditional routes for acute pain in the ED. The IN route may be a good alternative in scenarios where IV access is not feasible, patients are refusing injectable medications, or a fast onset of pain relief is needed.

Pharmacokinetics and pharmacodynamics of intranasal versus intravenous fentanyl in patients with pain after oral surgery. Foster D, Upton R, Christrup L, Popper L.  Ann Pharmacother. 2008 Oct;42(10):1380-7. doi: 10.1345/aph.1L168. Epub 2008 Aug 26. PMID: 18728103.


Ketamine Compared With Morphine for Out-of-Hospital Analgesia for Patients With Traumatic Pain: A Randomized Clinical Trial. Le Cornec C, Le Pottier M, Broch H, Marguinaud Tixier A, Rousseau E, Laribi S, Janière C, Brenckmann V, Guillerm A, Deciron F, Kabbaj A, Jenvrin J, Péré M, Montassier E. JAMA Netw Open. 2024 Jan 2;7(1):e2352844. doi: 10.1001/jamanetworkopen.2023.52844. PMID: 38285446; PMCID: PMC10825723.

Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists, Reg Anesth Pain Med. 2018 Jul; 43(5): 521–546. Published online 2018 Jun 7. doi: 10.1097/AAP.0000000000000808

"Low-dose ketamine versus morphine in the treatment of acute pain in the emergency department: A meta-analysis of 15" randomized controlled trials. Guo J, Zhao F, Bian J, Hu Y, Tan J. Am J Emerg Med. 2023 Dec 3;76:140-149. doi: 10.1016/j.ajem.2023.11.056. Epub ahead of print. PMID: 38071883.

A Systematic Review and Meta-analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department. Karlow N, Schlaepfer CH, Stoll CRT, Doering M, Carpenter CR, Colditz GA, Motov S, Miller J, Schwarz ES. Acad Emerg Med. 2018 Oct;25(10):1086-1097. doi: 10.1111/acem.13502. Epub 2018 Jul 17. Review.

RESULTS: Three studies met the criteria for inclusion in this meta-analysis. Compared to pain scale reduction with morphine, ketamine was not inferior (relative reduction = 0.42, 95% confidence interval = -0.70 to 1.54). No severe adverse events were reported in any study, but higher rates of nonsevere adverse events were observed with ketamine.

Low-Dose Ketamine for Acute Pain in the ED: IV Push vs Short Infusion? Rezaie S, REBEL EM, APRIL 10, 2017

Low dose ketamine use in the emergency department, a new direction in pain management. The American Journal of Emergency Medicine

Available online 2 March 2017

Comparing the analgesic efficacy of morphine plus ketamine versus morphine plus placebo in patients with acute renal colic: A double-blinded randomized controlled trial, Am J Emerg Med. 2018 Sep 3. pii: S0735-6757(18)30733-2. doi: 10.1016/j.ajem.2018.09.004. [Epub ahead of print]

Oxyde nitreux

Inhaled nitrous oxide for painful procedures in children and youth: a systematic review and meta-analysis. Poonai, N., Creene, C., Dobrowlanski, A. et al. Can J Emerg Med (2023).


Clinical pharmacokinetics of morphine. Lugo RA, Kern SE.  J Pain Palliat Care Pharmacother. 2002;16(4):5-18.


Pharmacotherapy for Neuropathic Pain: A Review, Diego Fornasari, Pain and Therapy 2017, 6 (Suppl 1): 25-33

Pharmacotherapy for neuropathic pain in adults: systematic review, meta-analysis and updated NeuPSIG recommendations, Lancet Neurol. 2015 Feb; 14(2): 162–173. Published online 2015 Jan 7. doi:  10.1016/S1474-4422(14)70251-0

Non pharmacologique:

Are non-pharmacologic pain interventions effective at reducing pain in adult patients visiting the Emergency Department? A Systematic Review and Meta-analysis, Jeffrey T Sakamoto, Heather Burrell Ward, Joao Ricardo Nickenig Vissoci, Stephanie A Eucker, Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine 2018 March 15
Conclusion: Nonpharmacologic interventions are often effective in reducing pain in the ED. However, mostexisting studies are small, warranting further investigation into their use for optimizing ED pain management

Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis, JAMA Intern Med, 2019 Nov 4;180(1):91-105. doi:10.1001/jamainternmed.2019.4917. Online ahead of print.

Opioïdes, Opiacés

Recommandations canadiennes 2017 sur l'utilisation des opioïdes pour le traitement de la douleur chronique non cancéreuse - National pain center

Clinical Implications of Opioid Pharmacogenomics in Patients with Cancer, Gillian C. Bell, Kristine A. Donovan, and Howard L. McLeod, Cancer Control 2015 22:4, 426-432

"Role of Opioid-Involved Drug Interactions in Chronic Pain Management", Bain, Kevin T. and Knowlton, Calvin H..  Journal of Osteopathic Medicine, vol. 119, no. 12, 2019, pp. 839-847.

Opioid metabolism. Mayo Clin Proc. Smith HS. 2009 Jul;84(7):613-24. doi: 10.1016/S0025-6196(11)60750-7. PMID: 19567715; PMCID: PMC2704133.

Opioid-free analgesia after surgery. Myles PS, Bui T.  Lancet. 2022 Jun 18;399(10343):2245-2247. doi: 10.1016/S0140-6736(22)00777-2. PMID: 35717974.

Postsurgical prescriptions for opioid naive patients and association with overdose and misuse, Brat G, Agniel D, et coll. BMJ 2018. 360:j5790.

Conclusions: Each refill and week of opioid prescription is associated with a large increase in opioid misuse among opioid naive patients. 

Opioid-related harms in Canada


Chronic use of tramadol after acute pain episode: cohort study. Thiels CA, Habermann EB, Hooten WM, Jeffery MM. BMJ. 2019 May 14;365:l1849. doi: 10.1136/bmj.l1849. PMID: 31088782 Free PMC Article

Conclusions People receiving tramadol alone after surgery had similar to somewhat higher risks of prolonged opioid use compared with those receiving other short acting opioids. Federal governing bodies should consider reclassifying tramadol, and providers should use as much caution when prescribing tramadol in the setting of acute pain as for other short acting opioids.