Douleur

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)

AINS

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.

Antidépresseurs

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

Intra-nasal:

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.

Kétamine:

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). https://doi.org/10.1007/s43678-023-00507-0

Morphine

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

Neuropathique:

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. https://doi.org/10.7556/jaoa.2019.136

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

Tramadol

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.